The key to keeping patients who are recovering from serious medical events from returning to the emergency room during the COVID-19 pandemic as hospitalization rates soar again could lie in a Houston medical program.
According to reports, Texas has reached over 1,400,000 cases, including over 23,950 deaths.
Grand-Aides is an organization of 1,500 nurse aides and medical assistants who check on patients after they’re discharged from the hospital to ensure that they’re taking medications, adhering to special diets and managing side effects at home.
The program was conceptualized in 2012 by Arthur “Tim” Garson, a health policy expert and former dean of academic operations at Baylor College of Medicine, but has gained renewed interest as fears of catching COVID-19 lead people to avoid seeking medical care.
“We don’t want to keep sick people out of the hospital,” Garson said. “What we would hope is that we would keep people from getting very ill after they're discharged.”
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Grand-Aides’ services, funded by hospitals or insurers, are free to patients. Within 48 hours of discharge, a grand aide contacts the patient. Aides usually pay a house visit three times the first week, tapering visits to once every four to six weeks as the patients adjust to diets and medication changes.
Patients receive 25 to 30 days of home visits. Grand-Aides ask patients to report any medical problems and take the report back to primary care doctors and specialists to determine whether they need to return to the hospital.
While the program’s aides have reduced in-person visits during the pandemic, the aides are using telemedicine to confirm that their patients are recovering safely.
After patients have been discharged from the hospital, they could experience minor symptoms such as that could snowball into a serious emergency if left untreated, but could be easily prevented or managed with the advice of a medical professional, said Garson. In some cases, programs such as Grand-Aides have reduced readmissions by more than 80 percent.
A program like Grand-Aides could be especially important for low and moderate-income patients who might not be able to afford additional follow-up care after they leave the hospital, said Ge Bai, a professor of health policy and accounting at Johns Hopkins University.
The programs also benefit hospitals. Medical centers need to reduce repeat hospitalizations or face federal penalties and downgrades to quality ratings if they have excessive readmission rates. Many conditions that send patients to hospitals are treatable at home or in a doctor’s office if caught early.
It’s part of the shift from fee-for-service models, where hospitals are paid based on how many services are rendered, to value-based care, where medical providers are paid according to their patients’ health outcomes.
“If their readmission rates are high, that becomes public record and there is a shaming effect,” Bai said. “If they’re billed as being low quality, then their profit margin is affected.”
At the University of Virginia Health System, Grand-Aides have been instrumental in reducing hospital admissions in the eight years since its implementation, said Craig Thomas, a nurse practitioner who oversees the medical center’s aides.
Thomas has two aides, who handle as many as 70 patients at a time. Since launching Grand-Aides, hospital readmissions are down an average of 82 percent within 30 days at the University of Virginia Health System after starting Grand-Aides, he said.
“Our patients were extremely worried about contracting coronavirus, and they were doing what others were doing, not going places,” Thomas said. “What it meant was that some of these chronic medical needs weren’t met because they’re not accessing care like they need to do.”
Home visits, even by telemedicine, can provide more meaningful information and care than hospitalization, he said. It’s easier to see social and environmental factors, such as the type of caregiver network and support system, that might slow a patient’s recovery or discuss day-to-day issues that may be forgotten by the next doctor’s appointment.
If a grand aide spots something in a home environment that could prohibit them from returning to full health, such as a lack of access to healthy food options or instable housing, they report back to primary care doctors and nurses to determine if there’s something they can do to remedy that.
Grand-Aides’ Garson said the program is working with several national insurance companies to develop long-term strategies for caring for patients. Grand-Aides also is collaborating with researchers at the University of Texas and University of Houston to study what type of interventions work best and how often they would need such care in the year following a major surgery or emergency.
“Hospital readmissions are often caused not by the treatment a patient received in the hospital, but by the social and environmental factors after the patient is discharged from the hospital,” said Bai, the Johns Hopkins researcher.
Providing the care that keeps people from returning to hospitals particuarly crucial now as coronavirus infection rates climb and patients fill hospital wards, experts said.
“Hospitals do not want to constrain their capacity because of patients unrelated to COVID,” Bai said.