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Severity of illness and risk of mortality in Mayo Clinic's virtual hybrid advanced care at home program: a

Margaret R Paulson1, Ricardo A Torres-Guzman2, Francisco R Avila2

  • 1Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA.

BMC Health Services Research
|March 27, 2023
PubMed

Insights

Advanced Care at Home (ACH) successfully manages high-acuity patients, demonstrating moderate to major severity of illness and risk of mortality. This hospital-at-home model shows a 0% in-program mortality rate, offering a viable alternative to traditional hospitals.

Area of Science:

  • Healthcare Delivery Innovation
  • Virtual Care Models
  • Hospital-at-Home Research

Background:

  • Mayo Clinic implemented Advanced Care at Home (ACH), a hybrid hospital-at-home (HaH) model, in July 2020.
  • The program serves both urban and rural settings, catering to diverse patient populations.
  • This initiative represents a significant shift towards high-acuity virtual care delivery.

Purpose of the Study:

  • To characterize the demographic profile of patients enrolled in the ACH program.
  • To assess patient acuity using Severity of Illness (SOI) and Risk of Mortality (ROM) metrics.
  • To illustrate the complexity and management capabilities of the ACH model for advanced therapeutic needs.

Main Methods:

  • Utilized All Patient Refined-Diagnosis Related Groups (APR-DRG) for SOI and ROM calculations.
  • Conducted individual chart reviews for data extraction from July 2020 to March 2022.
  • Analyzed demographic data, diagnoses, length of stay, readmission, and mortality rates.

Main Results:

  • 923 patients discharged with average SOI of 2.89 and ROM of 2.73.
  • Mean patient age was 70.88 years, with 54.6% males; average length of stay was 4.10 days.
  • Top diagnoses included COVID-19 (17.6%), heart failure exacerbation (12.7%), and septicemia (10.9%); 30-day readmission was 11.2%, 30-day mortality was 1.8%.

Conclusions:

  • ACH patients exhibit moderate to major acuity (SOI/ROM), indicating the program's capacity for complex care.
  • The ACH model effectively manages high-acuity patients requiring advanced treatments.
  • ACH demonstrates a 0% in-program mortality rate, positioning it as a strong alternative to traditional brick-and-mortar hospitals.
Abstract

Keywords:
Home hospitalRisk of mortalitySeverity of illnessTelemedicine

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