Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Kaiser Permanente Division of Research, Oakland, CA, USA.
Perm J. 2023 Dec 15;27(4):90-99. doi: 10.7812/TPP/23.059. Epub 2023 Oct 27.
Hospital at Home (H@H) programs-which seek to deliver acute care within a patient's home-have become more prevalent over time. However, existing literature exhibits heterogeneity in program structure, evaluation design, and target population size, making it difficult to draw generalizable conclusions to inform future H@H program design.
The objective of this work was to develop a quality improvement evaluation strategy for a H@H program-the Kaiser Permanente Advanced Care at Home (KPACAH) program in Northern California-leveraging electronic health record data, chart review, and patient surveys to compare KPACAH patients with inpatients in traditional hospital settings.
The authors developed a 3-step recruitment workflow that used electronic health record filtering tools to generate a daily list of potential comparators, a manual chart review of potentially eligible comparator patients to assess individual clinical and social criteria, and a phone interview with patients to affirm eligibility and interest from potential comparator patients.
This workflow successfully identified and enrolled a population of 446 comparator patients in a 5-month period who exhibited similar demographics, reasons for hospitalization, comorbidity burden, and utilization measures to patients enrolled in the KPACAH program.
These initial findings provide promise for a workflow that can facilitate the identification of similar inpatients hospitalized at traditional brick and mortar facilities to enhance outcomes evaluations for the H@H programs, as well as to identify the potential volume of enrollees as the program expands.
随着时间的推移，医院居家（H@H）项目——旨在在患者家中提供急性护理——变得越来越普遍。然而，现有文献在项目结构、评估设计和目标人群规模方面存在异质性，使得难以得出可推广的结论来为未来的 H@H 项目设计提供信息。
这项工作的目的是为 H@H 项目——北加利福尼亚州 Kaiser Permanente 的高级居家护理（KPACAH）项目——制定一个质量改进评估策略，该策略利用电子健康记录数据、图表审查和患者调查来比较 KPACAH 患者和传统住院环境中的住院患者。
作者开发了一个 3 步招募工作流程，该流程使用电子健康记录过滤工具生成每日潜在对照者名单，对潜在合格对照者患者进行手动图表审查，以评估个人临床和社会标准，并对潜在对照者患者进行电话访谈，以确认其资格和兴趣。
该工作流程在 5 个月内成功确定并招募了 446 名对照者患者，这些患者在人口统计学、住院原因、合并症负担和利用措施方面与 KPACAH 项目中的患者相似。
这些初步发现为识别传统实体设施中类似住院患者的工作流程提供了希望，以增强 H@H 项目的结果评估，并确定该项目扩大时的潜在入组人数。
