Hospital-at-Home Steps out of the COVID-Era Through New Atrium Health, Best Buy Partnership

Fierce Healthcare | By Annie Burky

Both Atrium Health and Best Buy Health employed their respective at-home care programs during the COVID-19 pandemic when hospitals were a hotbed for the virus and providers were scrambling to provide care.

Today, the duo announced a partnership to develop a new hospital-at-home offering for a post-pandemic world.

Atrium Health launched its virtual inpatient care program to treat COVID patients from the comfort of their own homes. Best Buy Health has grown its remote care enterprise solution through a series of acquisitions and partnerships with companies like Current Health and TytoCare.

Rasu Shrestha, M.D., chief innovation and commercialization officer at Advocate Health, Atrium’s parent company, believes that the new collaboration will illuminate at-home care and expand Atrium’s current offering.

“This transition that happens from discharging a patient from a hospital to the void of their home is the dark side of the moon: It's disconnected, confusing, expensive,” Shrestha told Fierce Healthcare. “What we've been doing in the past is working through our hospital home program and manually putting together a lot of these devices. By working with Best Buy Health, we're developing the seamless connected care experience and an opportunity to truly scale this.”

Since launching its hospital-at-home program in March 2020, Atrium has met 6,300 patients at home while redirecting 25,000 hospital bed days, according to Shrestha. “In the context of traditional brick-and-mortar facilities, that’s a 100-bed hospital,” he noted.

Atrium’s at-home hospital program was initially designed for COVID and COVID-presumptive patients. Now, the suite of solutions is meeting a growing cadre of patients diagnosed with chronic cardiac conditions, chronic obstructive pulmonary disease, pneumonia, asthma, infections and other medical and postoperative conditions.

Who is Most at Risk for Long COVID?

Harvard Medical School | By Jake Miller

A new study of more than 800,000 people has found that in the U.S., COVID "long haulers" were more likely to be older and female, with more chronic conditions than people in a comparison group who—after getting COVID—did not have diagnosed long COVID or any of the symptoms associated with long COVID. The findings are published in the March issue of Health Affairs.

The national study, which focused on people with private insurance or Medicare Advantage coverage, aims to inform public health and clinical care by advancing the understanding of who gets long COVID.

As one of the largest studies of long COVID in the U.S. to date, in terms of the number and diversity of people studied and the length of time symptoms and diagnoses were followed, the study solidifies many previous insights about the demographics and clinical profile of people most likely to get sick.

It also provides new information to consider about the complex interaction of COVID-19 in patients with previously diagnosed chronic illnesses.

"This work in a large population helps to address the question of who is more at risk of long COVID," said Zirui Song, associate professor in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School, lead author of the article.

"This may help clinicians and health care organizations screen, monitor, and treat patients more effectively. It may also help individuals, who know their own medical history, better assess their risk of long COVID and the value of protecting against getting COVID-19 in the first place," Song said.

The study's findings also indicate that symptoms of long COVID can appear or persist much longer after initial infection than many previous studies had suggested.

Most earlier work showed a peak of long COVID symptoms and diagnoses within the first six months of a person's initial COVID-19 diagnosis, the authors note, but the new research shows another, smaller peak around one year, which the authors note was significantly longer than the follow-up period of most initial studies.

Read Full Article

Exercise Found to Decrease Suicide Attempts in Those with Mental and Physical Illness

University of Ottawa | By Paul Logothetis

A new study from the University of Ottawa's Faculty of Medicine found patients with mental or physical illness were able to successfully adhere to exercise regimes despite previous thinking, resulting in decreased suicide attempts.

The findings cast doubt on the misconception that patients suffering from mental or physical illness are not motivated to participate in a physical exercise regime, which has similar efficacy to antidepressants and cognitive behavioral therapy in the treatment of depression. It's effect on suicidal behaviors, however, was unclear.

"This misconception has led to primary care providers under-prescribing exercise, resulting in further deterioration of patients' mental and physical health," says Dr. Nicholas Fabiano, a psychiatry resident and lead author of the study with medical student Arnav Gupta.

"The findings of this study 'debunk' this belief as exercise was well tolerated in those with mental or physical illness. Therefore, providers should not have apprehension about prescribing exercise to these patients."

Under the supervision of Dr. Marco Solmi and Dr. Jess Feidorowicz from the Department of Psychiatry, Fabiano and Gupta evaluated 17 randomized control trials with over 1,000 participants to deduct their findings, which are published in the Journal of Affective Disorders.

Payers Should Cover Home-Based Cardiac Rehabilitation Programs, Researches Argue

Fierce Healthcare | By Frank Diamond

Insurers need to rethink their coverage policies regarding home-based cardiac rehabilitation programs, according to a study published yesterday in the Journal of the American Heart Association.

In a press release, the study’s senior author Mary A. Whooley, M.D. said that “our biggest challenge in the U.S. is that home-based cardiac rehabilitation is not covered by many health insurers. Currently, Medicare only pays for on-site or facility-based cardiac rehabilitation.”

While problems persist on the supply side for providing these programs, the study also found a lack of demand.

“The biggest surprise of our analysis was how few patients chose to participate in cardiac rehabilitation,” Whooley said, a primary care physician at the San Francisco Veterans Affairs Medical Center and professor of medicine at the University of California, San Francisco.

HBCR programs focus on lifestyle changes. “However, changing behaviors is difficult, and while care facilities may offer on-site cardiac rehabilitation, many patients don’t choose to take advantage of follow-up treatment,” Whooley said.

The study, which authors tout as the first to show that home-based cardiac rehabilitation can help people with heart disease live longer, involved examining data of 1,120 patients eligible for cardiac rehabilitation at the San Francisco Veterans Health Administration between 2013 and 2018.

Excluded from the study were veterans who choose to attend facility-based cardiac rehabilitation programs or those who died within 30 days of hospitalization. Researchers compared outcomes for 490 home-based care participants to 630 patients who did not participate in the program. The patients were monitored through June 30, 2021.

Those in the home-based program had a 36% lower risk of death compared to those who did not participate.  

“Although no observational study can eliminate the possibility that healthier patients were more likely to participate in HBCR, we rigorously adjusted for confounding using an inverse probability weighted Cox regression analysis with the goal of equalizing the samples across all variables other than exposure to HBCR,” the study found. “These results suggest that participation in HBCR contributed to lower mortality among patients referred to [cardiac rehabilitation].”

The home-based rehabilitation program lasted 12 weeks and included nine coaching calls, motivational interviews and a health journal to track diet, exercise and vital signs. Participants were also given a stationary bike and a blood pressure monitor.

Patients were given physical activity goals, after consultation with a nurse or exercise physiologist. Follow-up calls were made to patients at three and six months after the program, and they were monitored an average of 4.2 years after being hospitalized.