Complex care, at home.
Winner, Health Quality Council of Alberta Patient Experience Award
Sarah Halprin receives hospital-level care at her home in Calgary as a patient in the AHS Complex Care Hub (CCH). She gets regular visits from community paramedics — here, by Trent Gahan — with virtual consultation with CCH physicians.
Sarah appreciates the freedom provided by the program, a virtual in-patient unit that started at Rockyview General Hospital in 2018 and expanded to South Health Campus a year later. Instead of potentially lengthy hospital stays, healthcare comes to her house.
She can sleep in her bed, rest, eat her own food, and take care of her pets.
"I had never heard of anything of its kind," Halprin says of the collaboration between physicians, nurse navigators, community paramedics and IT professionals.
"I was absolutely blown away that this even existed."
The Complex Care Hub also frees up hospital beds, reducing strain on the healthcare system.
The Complex Care Hub is based on the international hospital-at-home movement. "Research shows that, for every 50 patients treated in a hospital at home, compared to a group of patients treated in a bricks-and-mortar hospital, you save one life,” says Dr. Michelle Grinman, a driving force behind the program at AHS.
Paramedics perform assessments, lab work and ECGs requested by CCH physicians. And, as part of the care continuum, patients are connected with community resources to have home care, physiotherapy, occupational therapy and social work.
"It gives patients a better experience because they have more control over their healthcare," Dr. Grinman says. "They can follow their routines and be at home ... while getting their acute care."
Data show that, even in the 90 days after patients leave the program, there are fewer re-admissions, emergency department visits, and EMS calls.
"It has the potential, as it grows, to help with sustainability in the healthcare system," says Dr. Grinman.
Complex Care Hub patients are often those who need non-emergent treatment that could only be provided within hospital walls prior to the existence of the program.
Instead of being transferred from the Emergency Department to recover in a hospital unit, or having prolonged hospital stays, they return home, where their care is overseen by healthcare professionals.
Patients monitor their own vital signs — blood pressure, heart rate, oxygen saturation, temperature, weight — and tablets upload the data to a web portal that doctors access on their laptops.
"They can see it in real time," says Halprin. "And on this tablet, you can do a consultation with the doctor. So instead of having to go into the hospital ... I was able to do that from home. It's incredible." Zoom calls allow for more convenient and efficient scheduling, and a virtual visit with a physician means community paramedic visits can be reserved for patients who need physical assessments and treatments.
Occasionally, in-person visits with the doctor are necessary. "We have clinic space in each hospital site where our physicians and our nurse navigators can see the patient," says Dr. Grinman. "We can give them certain interventions and try to keep them out of the hospital."
No longer a pilot project, the Complex Care Hub won a Patient Experience Award in May from the Health Quality Council of Alberta.
Feedback from patients has been positive
"They felt like they were more in control, that they could call and ask questions," says Dr. Grinman. "Patients often use words like, 'I feel safe,' or, 'I'm happier,' or, 'I got to go to my 90th birthday party,' or 'I got to see my niece or my grandchild.' We hear that a lot. We kind of undervalue how much that impacts people's psychological well-being when they're in the hospital."
Even fellow physicians have expressed gratitude, especially when family members or their patients end up referred to the program. "I often get, 'Thank you so much.'”
Dr. Grinman notes that research shows that older adults who spend a lot of time in bed in conventional hospital settings often suffer functional decline and, as a result, have a higher chance of ending up in long-term care. Complex Care Hub can help to avoid or delay that. But even with the initiative’s success, its profile remains modest. "We're seen as this small but mighty team that is shifting a little bit the paradigm of how we provide acute care,” she said. Dr. Grinman is now helping to organize the Rural Home Hospital program in Wetaskiwin Hospital and Care Centre in collaboration with a research team from Harvard Medical School. "The plan would be to adapt this type of model to reach other populations," said Dr. Grinman. "That's one of AHS's priorities, not just to serve Calgary and Edmonton, but also be able to serve rural and remote populations." She is buoyed by the framework already in place. "What we have now is the scaffolding," said Dr. Grinman. "Within five years, what we'll probably see is that that same blueprint will be expanded, then locally adapted."
