CEDAR RAPIDS — After seeing positive outcomes among patients involved in its newest initiative, Mercy Medical Center expanded a home health care program for COVID-19 positive patients this week.
As of Jan. 4, patients recovering from the novel coronavirus can be discharged from the Cedar Rapids hospital into the COVID at Home program, allowing them to recover at home while being monitored daily by a Mercy Medical provider.
When it launched Dec. 1, the program applied to patients discharged from a Mercy Medical emergency room.
Officials opted to expand the home health care initiative this week after seeing success in the first month, said Tawnya Salsbery, senior director of post-acute and senior services.
Of the more than 30 patients who have gone through the program so far, none have returned to the emergency room for care and none have been admitted into the hospital. Of those total patients, 16 had at least three chronic medical conditions that put them at risk for severe COVID-19 illness, according to Salsbery.
Twenty-nine patients have been admitted to the program through the emergency room, and three have been admitted from an inpatient floor.
According to Salsbery, hospital officials first started having conversations in late October on how the organization “can care for people that are ill, but not so ill that they need to be admitted into the hospital.” Thus, the COVID at Home program was created.
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“We wanted to make sure we take our time and didn’t rush our program,” Salsbery said.
To find the line between patients who were well enough to not need a hospital stay, but sick enough to require further care, Mercy Medical providers refer to guidelines developed by the American College of Emergency Physician.
The Emergency Department COVID-19 Severity Classification scores patients’ illness based on symptoms and risk factors, among other criteria.
Patients discharged from Mercy Medical — either from its emergency room or from an inpatient admission — are sent home with a self-monitoring kit, including a pulse oximeter that monitors oxygen-saturation levels.
On average, patients stay in the program for eight days. During that time, one of two Mercy Medical nurses on the home health team travels to the patient’s home daily to check his or her symptoms and monitor the illness.
In addition, the patient has daily video visits with a physician or nurse practitioner to monitor progress. These calls take place while the Mercy Medical nurse is in the home with the patient.
Salsbery said this aspect of the program not only is important to ensuring providers have accurate information on the disease’s progress, but to help those patients who may not be comfortable with using telehealth.
“We wanted to ensure that 100 percent of the time, a patient was being seen by a physician or a nurse practitioner,” she said.
The average age of patients in the program is 66 years, Salsbery said.
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Mercy Medical did not receive additional funding to launch this program, though there are dollars available for in-home COVID-19 care through government entities such as Medicaid and Medicare. Hospital officials said though that is currently “not the focus of our program,” they may seek out supplemental funding if the program is expanded to include other critically ill patients who receive care at home.
Salsbery said she predicts the program will be covered by patients’ health insurance.
Home health care services have shifted in the midst of the pandemic as more hospitals look for ways to preserve bed capacity while maintaining care of COVID-19 patients.
About one in 10 patients hospitalized with COVID-19 are discharged home with home health services, according to the federal Centers for Medicare and Medicaid Services.
A study of COVID-19 patients in New York discharged to home health care between April and June found that most achieved “significant improvements in symptoms and function,” according to the data published in the Annals of Internal Medicine. Of the more than 1,400 patients, 10 percent were hospitalized and eleven patients died, the data shows.
The Cedar Rapids hospital’s program is similar to a virtual hospital model created by the University of Iowa Hospitals and Clinics in the early days of the pandemic in the spring, called the UIHC Home Treatment Team.
UIHC providers have overseen care for more than 1,000 high-risk patients — but only a small percent have required a hospital visit as of November. Officials told The Gazette the virtual hospital program played an important role in helping the hospital maintain bed capacity when new COVID-19 cases were driving record-breaking number of hospitalizations statewide.
Mercy Medical’s goal for the COVID at Home program is to help maintain capacity at its hospital for severely ill COVID-19 patients in case there is another surge of hospitalizations in the coming days of the pandemic.
Patients interested in Mercy Medical’s COVID at Home program can find more information by calling (319) 398-6203.
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