SHM Converge Scientific Abstract ePoster Gallery-Increasing Hospital Capacity by Vertically Integrating a Home Health Agency

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The University of Utah Health and Community Nursing Services created “Heal at Home,” a vertically integrated home-health program designed to increase hospital capacity by moving appropriate post-acute care from the hospital to patients’ homes. This model was developed in response to common capacity problems at academic medical centers, including ED boarding, delayed elective procedures, and slow transfers from other hospitals.<br /><br />Unlike traditional hospital-at-home programs, Heal at Home uses the existing home health benefit covered by most insurance plans, making it more sustainable and less dependent on special reimbursement waivers. The program uses predefined care pathways, shared patient education, specialty-specific training, and clear escalation protocols to support safe transitions from inpatient care to home across multiple specialties.<br /><br />By combining the University’s clinical expertise with the home health agency’s infrastructure and staff, Heal at Home aims to reduce length of stay while maintaining safe outcomes and consistent messaging for patients. The program spans both medical and surgical specialties, with established services including breast surgery, colorectal surgery, emergency medicine, general surgery, neurosurgery, orthopedics, hospital medicine, urogynecology, urology, vascular surgery, and others.<br /><br />From January 2022 to January 2024, the program enrolled 465 patients and is estimated to have saved 340 bed days. Outcomes were favorable, with a 30-day ED visit rate of 8.4%, 30-day readmission rate of 4.9%, zero mortality events, and 95% of patients saying they would recommend the program. These results compare favorably with all University discharges to home health, which had a 16.1% unplanned readmission rate.

Asset Subtitle

Jared Huber

Meta Tag

Author List Allison Wood, Jacob Kean, Jared Huber, Juan M. Hernandez, Liza J. Johnson, Michael Sanchez, Peter Weir, Steven M. Hayworth, Valerie M. Vaughn

Category Innovations

Concept Vertical Integration

Concept Inpatient Length of Stay

Concept Home-Based Acute Care

Concept Home Health Agency

Concept Hospital Capacity

Distinguished Finalist

Presenter Organization University of Utah

Presenting Author Jared Huber

Track Transitions of Care

Keywords

hospital-at-home

home health

post-acute care

hospital capacity

length of stay

academic medical center

care pathways

readmission rate

patient outcomes

vertical integration

Vertical Integration

Inpatient Length of Stay

Home-Based Acute Care

Home Health Agency

Hospital Capacity