Background: Hospital at home is a novel healthcare delivery model offering acute inpatient care outside hospital walls. In the United States, hospital at home programs are almost exclusively offered in urban settings. Many rural regions of the United States have difficulty with adequate healthcare access, and there is little data on rural hospital at home programs. Levine et al. (2020) showed home hospitalization reduced cost, health care use, and readmissions. An Albuquerque home hospital program based on the Johns Hopkins model showed savings of 19% over costs for similar inpatients (Cryer et al., 2012). These and other studies show health outcomes are not significantly different, although physical activity among home hospital patients was higher, home hospital patients experienced lower lengths of stay and had fewer lab and diagnostic tests. Telemedicine, integral to rural healthcare, can provide better support for underserved rural areas, small hospitals without intensivists, and large hospitals with low-intensity physician staffing models or nocturnal physician shortages (Wilcox and Wiener-Kronish, 2014).

Purpose: Mayo Clinic partnered with Medically Home, a company in Boston, MA specializing in implementing home hospital programs, to open its hospital at home program, advanced care at home, in summer 2020 at Mayo Clinic Florida (MCF), an urban destination medical center, and in Northwest Wisconsin (NWWI), a rural community practice. This initiative is innovative in combining rural and urban spaces under a single home hospital platform. The command center based in Jacksonville on the MCF campus coordinates care remotely in NWWI. While MCF primarily utilizes an outsourced supplier network, NWWI primarily insources their supplier network. Mayo Clinic wished to determine if a rural hospital at home program was feasible.

Description: Mayo Clinic in NWWI serves patients in five counties in rural Wisconsin, including a 224 bed community hospital with four surrounding critical access hospitals. The patient population is primarily working class and white. Advanced care at home in NWWI served 33 patients between August and November 2020, including 16 patients with COVID-19 receiving IV remdesivir therapy. This home hospitalization model relied heavily on its existing Mayo hospital resources to provide acute care to the home, including community paramedicine, home health, nursing, and pharmacy.

Conclusions: Mayo Clinic successfully established advanced care at home in NWWI, demonstrating the innovative execution of a hospital at home program in a rural setting. This implementation required unique strategies that do not fit within established systems in urban centers. Challenges included rural connectivity technologies, admission innovations, and rural supplier networks and transportation. Future efforts should focus on integrating physician and nurse care with community paramedicine, emergency department, pharmacy, and internet technologies. This alternative to brick-and-mortar hospitalization was especially critical during the COVID-19 pandemic when all five hospitals in NWWI lacked capacity due to a large surge in COVID-19 cases.