Scaling Virtual Wards Requires Culture and Data Shifts, Says MGB’s Shiv Sutaria
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Shiv Sutaria, assistant chief information officer for Mass General Brigham Healthcare at Home, argues that the future of acute medical care is shifting to patients’ homes. Providing acute care at home has grown in popularity due to bed shortages in traditional hospitals, with over 360 hospitals across 37 US states now delivering this type of care. However, Sutaria explains that the main challenge lies not in the technology, but in the required changes in data management, staff culture, and ensuring patients and their families are treated with the right care and respect.
The Hospital-at-Home Model: A Clinical and Cultural Revolution
Mass General Brigham’s assistant chief information officer, Shiv Sutaria, argues a significant shift in clinical data management and staff attitude is required to scale up virtual wards, as the US extends its hospital-at-home regulatory waiver. Sutaria identifies that with over 360 hospitals across 37 US states now offering acute care outside their physical walls, the key challenge isn’t technology, but human change management and data regulation.
Highlighting the “win-win-win” scenario of the post-pandemic virtual ward boom, Sutaria discusses the potential danger of overwhelming clinical staff with continuous medical data, and the necessity to protect families by treating medical teams as guests.
Changing the Face of Traditional Care Delivery
The home hospital model originated as a research pilot in 2016 at Mass General Brigham (MGB) to investigate if the quality of care was on par with that of traditional hospital settings. The model accelerated during the COVID-19 pandemic due to the Acute Hospital Care at Home waiver launched by the Centers for Medicare & Medicaid Services (CMS) in the US. The waiver provided necessary regulatory and financial frameworks, and formal authorisation, to tackle the pandemic.
As the model expanded, research confirmed superior clinical outcomes, lower mortality, decreased need for patient discharge to rehabilitation facilities, and lower readmission rates. This cost-effective model is now deployed in approximately 365 hospitals across 37 states in the US.
Redesigning Clinical Care for Home Settings
Implementing a programme like this demands a massive change management effort, requiring a complete culture shift for the entire staff, patients and their families.
Addressing this mindset is critical for successful change management. It involves demonstrating to people the value of this programme, its excellent clinical outcomes, and its suitability for patients.
Role of Families in the Care Model
The design of this programme ensures the provision of ancillary services to patients, such as home health aides and food services. It is essential to be aware of the caregiver’s role during the design phase to minimise their impact and ensure the patient does not feel like a burden to their family.
Managing Data Overload in Remote Patient Monitoring
Remote patient monitoring can lead to data overload. It is crucial to do thorough due diligence when choosing a remote patient monitoring company and to determine the type of data crucial for patients. Over time, operational experience has led to a reduction in constant data feeds, shifting instead towards periodic checks.
Safety Assurances in Home Hospital Environments
Ensuring patient safety in a home hospital model involves evaluating individual patient needs and maintaining a level of oversight. This approach reflects the slow, day-by-day recovery process of patients.
Cost Implications of the Home Hospital Model
Demonstrating a meaningful cost reduction for the health system requires significant scale operation. The cost to patients varies depending on their insurance coverage. However, most studies show reduced financial burden on participating health systems. The home hospital model does not cost more than traditional hospital stays.
Potential for the Home Hospital Model Outside the US
Similar initiatives exist in Canada, Italy, the UK, Australia and Saudi Arabia. The World Hospital at Home Congress, an academic organization, helps in shaping the future direction of this care model. Despite encountering different payer environments and local regulations, this model is expected to pick up speed across the globe.
Future Expectations of the Home Hospital Model
Since January 2022, the home hospital programme has served 10,000 patients at Mass General Brigham, saving around 50,000 bed days. With the CMS waiver extended until 2030, many health systems are expected to build out their own operations, furthering this model’s momentum globally.
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