Background: “Hospital at Home” (HaH) models of care have existed for over 20 years in the U.S. More recently, HaH models have evolved to include transitional care solutions to improve patients’ post-acute outcomes. Meanwhile, services which were traditionally provided only in the inpatient setting, such as elective arthroplasty, have begun to shift to same-day and outpatient management in response to changes in practice patterns, payment structure, and inpatient bed capacity constraints. Traditional, hospital-based innovations meant to improve surgical outcomes such as hospitalist co-management and ERAS pathways are not typically available to support this new mode of procedural management. Our OrthoBridge program brings hospitalist co-management into patients’ homes to improve patient outcomes while facilitating efficient patient flow, reducing unnecessary re-admissions, and reducing total cost-of-care.
Purpose: To innovate and deploy a hospitalist-orthopedist co-management model to provide safe and high-quality transitional care in patients’ homes before and after elective arthroplasty.
Description: DispatchHealth has built an in-home medical practice model in more than 50 U.S. cities utilizing mobile teams of emergency physicians, advanced practice providers, and emergency medical technicians. Our innovation, called OrthoBridge, leverages existing DispatchHealth practice infrastructures to support enhanced in-home care capabilities. To serve our OrthoBridge patients, we deploy clinical teams consisting of hospitalist physicians, hospitalist-trained APPs, operations leaders, and nurse navigators. We designed standardized clinical work-flows for hip and knee arthroplasty and, with payer leaders and our orthopedic colleagues, co-developed evidence-based risk stratification protocols to help us select appropriate patients for the service. The care model involves a pre-procedural onboarding visit from one of our APP and RN teams to perform a home safety assessment, reconcile medications, ensure pre-procedural protocols have been followed, and provide patient and family coaching. The patient then proceeds to their procedure and is followed by our teams after discharge and is provided a combination of in-person visits, intensive care-management, and remote patient monitoring to project the orthopedic team’s post-procedural care plan into the patient’s home. Our program launched in November 2022, is in the pilot-phase and we have enrolled 3 patients to date. We will be collecting clinical outcomes as well as patient and provider satisfaction (NPS) data to guide subsequent iterations of this work.
Conclusions: As elective procedures have moved to same-day and outpatient surgical plans, outcomes can be improved by projecting pre-procedural and recovery plans into patients’ homes. Hospitalists are uniquely positioned to design, lead, and innovate co-management for orthopedic procedures in the home. Our model leverages an existing mobile in-home practice infrastructure to manage medically complex patients who can still benefit from same-day or outpatient surgery and can avoid hospitalization with the help of additional clinical support. Co-evolution with payer partners and orthopedic specialists has facilitated the development and deployment of this pilot program to offer patients safe, effective peri-procedural and transitional care in the home.