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July 22, 2020

Here's how Northwell Health is treating 'acutely ill' Covid-19 patients—in their own homes

Daily Briefing

    As new coronavirus cases skyrocketed in New York during the spring, Northwell Health launched a hospital-at-home program for severely ill Covid-19 patients to help boost hospital capacity—and now, this approach may be put to use by hospitals in Florida and other states facing coronavirus infection surges, Roni Caryn Rabin writes for the New York Times.

    4 steps to develop a successful Hospital at Home program

    A distinct, at-home program for Covid-19 patients

    Although hospital-at-home programs aren't new, they've typically been established to care for patients with chronic conditions, such as heart failure. However, in response to America's coronavirus epidemic, CMS earlier this year expanded access to home health services by loosening requirements for Medicare's home health benefit. The relaxed regulations allow home health agencies to provide care to patients under Medicare's home health benefit when medical practitioners have recommended patients stay at home because they have a condition making them more likely to contract the virus, or if they have a confirmed or suspected case of coronavirus infection.

    Thomas McGinn, Northwell's SVP and deputy physician-in-chief, and his colleagues developed the program to handle New York's spike in coronavirus cases. The program is designed to free up hospital beds for Covid-19 patients who need in-person care by allowing Covid-19 patients who don't require hospitalizations to receive care at home. And while other hospitals have launched comparable programs to treat recently discharged Covid-19 patients, Northwell's is distinct in that it providers at-home care to "acutely ill Covid-19 patients in the community," the Times reports.

    How it works

    Under the program, a team of Northwell specialists monitors and advises providers and patients in the community who are dealing with mild or moderate symptoms of Covid-19. The program also provides at-home care to Covid-19 patients who have been discharged from the hospital but continue to show symptoms of the disease that require medical attention.

    When necessary—such as with patients who have severe symptoms of Covid-19 or underlying conditions that make a coronavirus infection particularly dangerous—the hospital will send nurses and equipment to patients' homes to provide them with care. A pulmonologist will also observe patients via telehealth and consult with providers over the phone, though Gita Lisker, a Northwell critical care physician and lung specialist, said patients in the program who experience respiratory distress are hospitalized.

    Overall, from April 27 to June 1, Northwell enrolled 182 patients, ranging in age from 24 to 100, in its home-care program. According to Rabin, many of the patients had underlying chronic conditions, such as diabetes or obesity, which researchers have tied to more severe cases of Covid-19. And several of the patients were older and lived alone.

    One such patient—Joan Murray, a 77-year-old retired RN—was cared for at home in May. She had been resting at home with Covid-19 for about a week when her fever shot up to 103 and her oxygen levels fell—but she knew she didn't want to go to the hospital. In response, Northwell sent over a nurse manager with full protective gear to assess Murray's health.

    The nurse determined Murray was dehydrated and needed supplemental oxygen. Within hours of the assessment, Murray was connected to an intravenous line to replenish her fluids and an oxygen machine had been brought to her house, Rabin reports.

    Over the next week, nurses stopped by Murray's home to check on her every day, said Lisker, and Lisker called Murray daily to check her status.

    Why the program started—and where it's going next

    At the height of New York's coronavirus outbreak, McGinn said "80 to 90% of the patients who had the virus never went to the hospital." According to McGinn, while many of the state's Covid-19 patients did not need to be monitored in person, a few did but refused to be hospitalized.

    "Hospitals were becoming this place that scared everybody," McGinn said. Some patients feared they would contract the coronavirus at a health care facility if they hadn't already. Others were afraid they might lose contact with their family and friends because hospitals were prohibiting visitors to prevent the coronavirus' spread.

    And when Northwell started the program, McGinn and Lisker said many physicians had concerns about managing patients at home. However, since then, Northwell's physicians have grown comfortable with the program, as they've learned more and developed evidence-based protocols to teach patients how to monitor their temperatures, report health changes to their providers, and use pulse oximeters to track their blood oxygen levels.

    Now, Northwell is teaming up with physicians in states experiencing new surges in coronavirus cases—such as Florida, which is currently an epicenter of the global coronavirus pandemic—to launch similar programs. Northwell is also planning to expand its program to prepare for a possible second surge in coronavirus cases in New York.

    "If there is resurgence in New York, on a dime we can get this up and running in huge numbers, and other cities can do this, too," Lisker said. "It's a win for the patient and a win for the health system" (Rabin, New York Times, 7/18).

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