Boston-based Mass General Brigham, one of the leaders of the acute hospital-at-home movement, has received a grant to evaluate the delivery of short-term rehabilitation services in the home.
With a $4.6 million grant from the Massachusetts Executive Office of Health and Human Services (EOHHS), the health system will conduct a randomized controlled trial to evaluate the effect of providing short-term rehabilitation care in the home compared to a skilled nursing facility (SNF).
Nationally, about 40% of older adults discharged from acute care hospitals require some form of post-hospital care, and about half of them receive care in an inpatient skilled nursing facility. The cost of skilled nursing facilities is rising, and the COVID-19 pandemic exacerbated staffing shortages and capacity challenges facing these post-acute care facilities.
Delays in discharging patients from acute care hospitals to post-acute care settings have posed a challenge that has contributed to capacity issues across the country, preventing patients from accessing the rehabilitation care they need and preventing beds from becoming available for new patients needing acute hospital care.
Hospitalized patients can wait weeks or months to find a bed in a skilled nursing facility and access the care they need. According to the latest report from the Massachusetts Health and Hospital Association, 1,792 patients are waiting to be discharged from hospitals across the state.
“If successful, this model of care could lead to a complete transformation of how we deliver advanced rehabilitation care to our patients,” said David Levine, MD, MPH, MA, clinical director of research and development for Mass General Brigham’s Healthcare at Home program, in a statement. “There are not enough rehabilitation beds in Massachusetts, and if we can substitute facility-based care for home-based care, we may be able to help alleviate the capacity crisis our healthcare systems have been experiencing across the state. This would have an immediate benefit to patients, family caregivers, and physicians,” added Levine, who is the principal investigator on the trial.
As part of the study, 300 patients will be enrolled at five acute care hospitals in the Boston area: Massachusetts General Hospital, Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, Boston Medical Center, and Cambridge Health Alliance. Of those 300 patients, 150 will be randomly assigned to receive short-term rehabilitation care at home, while 150 will receive care in the traditional skilled nursing facility.
Patients admitted for in-home rehabilitation care will see a nurse, certified nursing assistant, physician, and home health aide upon admission. Aftercare will include daily remote visits from a physician and certified nursing assistant in the home. Physical, occupational, and speech therapies are also available and are tailored to the needs of patients. Patients will also receive 24-hour in-home responses from mobile integrated health paramedics and, as needed, care from a home health aide.
Researchers will also assess the experiences of family caregivers and clinical staff, examining burden and burnout among those groups.
In 2019, Levine and colleagues conducted a randomized, controlled pilot trial with 10 patients to test the ability to provide SNF-level care in the home. The results were promising, pointing to lower cost and improved patient experience compared with traditional SNF care, Mass General Brigham said. However, the small patient cohort required replication with a much larger patient cohort.
“Now, thanks to this EOHHS grant, we can pilot this innovative care delivery model that reinvents the way we deliver post-acute care,” Levine said. “At Mass General Brigham, we are a leader in the field of advanced home care. One of our goals is to build the evidence base that will be a path forward for the nation’s health care systems across the country.”
