BRINGING HEALTHCARE TO PATIENTS' HOMES - DESCRIPTION OF A MOBILE INTEGRATED HEALTH PROGRAM IN DETROIT, MICHIGAN

ABSTRACT

STATEMENT OF PROBLEM/QUESTION The United States healthcare system is plagued by rising healthcare costs, variable care quality and patient outcomes, and highly fragmented service delivery with many transitions of care. Mobile integrated healthcare (MIH) programs can add value by bringing healthcare to patients' homes. DESCRIPTION OF PROGRAM/INTERVENTION The aim of our MIH program is to bring medical resources to patients' homes to increase the availability and intensity of medical care at vulnerable times, during which patients have high risk of escalation of care to an emergency department (ED) or hospitalization. Patients must be age ≥17, live within a 3-county area, and have medical needs that require significant surveillance or would otherwise necessitate hospitalization. Once referred, a MIH paramedic (MIH-P) schedules and performs an in-home visit. MIH physicians are available for phone or video consultation. Primary exclusions include unsafe living environment or homelessness and active substance use disorder. Insurance is not a consideration. The program received an initial startup grant from Blue Cross Blue Shield and financial support for operations is primarily provided by Henry Ford Health System. MEASURES OF SUCCESS Outcome measures are tracked with an interactive dashboard. Process measures include time from referral to patient visit, percent of competed referrals, number of interventions performed during home visits. Key outcome measures include number of subsequent ED visits and hospitalizations. FINDINGS TO DATE From April 20, 2020 to December 31,2021, the MIH program received 4979 referrals and completed 3264 initial appointments (65.6% of referrals received) with a total of 5528 encounters completed. Referrals came from providers in the ED (42.3%), internal medicine inpatient and outpatient (27.2%), family medicine (4.1%), a COVID monoclonal antibody infusion program (18.6%), and medical/ surgical specialists (7.2%). Average travel time was 20.3 minutes and average time on scene was 69 minutes. Approximately 55.2% of patients had an estimated income of ≤ $41,000 based on US Census data. About 44.1% of patients were age ≥ 70. Patients were 49.7% non-Hispanic Black, 36.8% non-Hispanic White, 1.8% Asian/ Middle Eastern, 0.2% Hispanic, 11.4% other/ unknown/ declined. Of all MIH encounters, there was a 23.7% ED visit rate within 90 days (34% within 7 days, 30% 8-30 days, 36% 31-90 days) and a 10.5% hospitalization rate within 90 days (40% within 7 days, 24% 8-30 days, 36% 31-90 days). KEY LESSONS FOR DISSEMINATION Implementation and success of our MIH program relied on a group of dedicated paramedics, health system investment, and continued outreach to referring providers. Promoting sustainability will require continued efforts to demonstrate value of the program and to obtain reimbursement for the valuable and unique services provided by MIH.