Mass General Brigham to Test SNF-at-Home Model
Boston-based Mass General Brigham, one of the leaders of the acute hospital-at-home movement, has received grant funding to evaluate the delivery of short-term rehab care at home.
With a grant of $4.6 million from the Massachusetts Executive Office of Health and Human Services (EOHHS), the health system will run a randomized controlled trial to test the effect of delivering short-term rehab care at home vs. at a skilled nursing facility (SNF).
Nationally, about 40% of older adults discharged from acute care hospitals require some sort of post-hospital care, and about half of those receive care in an inpatient skilled nursing facility. The cost of skilled nursing facilities is increasing, and the COVID-19 pandemic exacerbated the staff shortages and capacity challenges these post-acute care facilities face.
Delays in discharging patients from acute care hospitals to post-acute care settings have posed a challenge that has contributed to capacity issues nationwide, preventing patients from accessing the rehab care they need and preventing open beds for new patients in need of acute hospital care.
Hospital patients can wait for weeks or months before finding a SNF bed and accessing the care they need. According to the latest report by the Massachusetts Health & Hospital Association, 1,792 patients are awaiting to be discharged from hospitals across the state.
“If successful, this care model may lead to a complete transformation of how we deliver advanced rehab care to our patients,” said David Levine, M.D., M.P.H., M.A., clinical director for research and development for Mass General Brigham’s Healthcare at Home program, in a statement. “There are not enough rehab beds in Massachusetts, and if we can substitute facility-based care with home-based care, we will be able to help alleviate the capacity crisis that our healthcare systems have been experiencing across the state. This would have an immediate benefit for patients, family caregivers and clinicians," added Levine, who is principal investigator of the trial.
As part of the study, 300 patients will be enrolled from five acute care hospitals in the Boston area: Massachusetts General Hospital, Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, Boston Medical Center and Cambridge Health Alliance. Of those 300, 150 patients will be randomized to receive short-term rehab care at home, while 150 will receive care in the traditional skilled nursing facility.
Patients admitted to rehab care at home will see a nurse, certified nurse assistant, physician, and home health aide upon admission. Subsequent care will include daily remote physician and in-home certified nurse assistant visits. Physical, occupational, and speech therapies are also available and tailored to patients’ needs. Patients will also receive 24-hour, in-home responses from mobile integrated health paramedics and, as needed, home health aide care.
Researchers will also evaluate the experiences of family caregivers and clinical staff, examining burden and burnout among those groups.
In 2019, Levine and colleagues ran a pilot randomized controlled trial of 10 patients to test the ability to deliver SNF-level care at home. Results were promising and pointed toward lower cost and a better patient experience compared to traditional SNF care, Mass General Brigham said.. However, the small patient cohort required replication with a much larger patient cohort.
“Now, thanks to this financial award by EOHHS, we can test this innovative care delivery model that reimagines how we deliver post-acute care,” Levine said. “At Mass General Brigham, we are leaders in the advanced home-based care space. One of our goals is to create the evidence base that will be a pathway for the country’s healthcare systems to follow nationwide.”
