Advanced Care at Home

Chad R. Nelson, M.D., Medical Director Advanced Care at Home, Mayo Clinic Arizona: We are pleased to share Mayo Clinic's Advanced Care at Home, hospital-at-home program with you. Advanced Care at Home is part of Mayo Clinic's vision to provide care in innovative ways by offering eligible patients hospital-level care in the comfort of their own home. In the program, health and safety are at the center of our care, which combines both virtual and in-home assessments to meet your individual needs.

Wendelyn Bosch, M.D., Medical Director Advanced Care at Home Command Center, Mayo Clinic in Florida: This combined care model is led by a Mayo Clinic physician working together with a care team of advanced practice providers, pharmacists and nurses to provide virtual hospital care from a command center on the Mayo Clinic campus. The command center works directly with Mayo Clinic staff and community-based care partners who provide in-person care directly in your home. This collaboration matches the care you would receive in the hospital.

Dr. Nelson: Once enrolled in Advanced Care at Home, you are transported home, where you will meet one of our community-based partners. They will spend the next hour admitting you into the program. Admission involves a physical assessment of your health, a safety assessment of your home and the setup of technology needed to support your virtual care. Our partners will teach you how to use each piece of technology and ensure the equipment functions properly.

Dr. Bosch: The technology setup includes a tablet that shows your daily scheduled appointments and allows you to start a video chat with your nurse at any time day or night. If you have a question or start to feel worse, you can simply push a button and your nurse or physician will be on the screen ready to talk to you. The rest of the kit includes:

• A blood pressure cuff.
• A scale to monitor your weight.
• A device to measure your oxygen levels.
• A personal emergency response bracelet or necklace that should be worn in case you need urgent help.
• A telephone that dials directly into the command center for a media connection to your care team.
• A Wi-Fi extender.
• And lastly, a backup power supply in the event of a power outage.

Dr. Nelson: While enjoying the convenience and flexibility of being at home, the first few days in Advanced Care at Home are like a hospital stay. While enrolled in in our hospital-at-home program, you must stay in your home for the duration of your care. Expect delivery of medications, supplies and other equipment to provide hospital-level care in your home. You will have daily virtual visits with a Mayo physician or advanced practice provider. If necessary, in-person visits by an advanced practice provider may occasionally occur. Nurses, community paramedics and other care team members are deployed to your home based on your Mayo Clinic physician's directions. These in-person visits may happen several times and can be early in the morning or late in the evening depending on your care needs.

Dr. Bosch: In addition to the in-person visits, your nurse visits you virtually about four times a day to help you take your medications, take your vital signs and see how you're feeling.

When patients need specialized tests or procedures that can only be done in our brick-and-mortar hospital, we arrange transportation to and from the Mayo Clinic hospital so you can continue your hospitalization at home.

Dr. Nelson: We know family and friends can often be a great support system. We welcome the opportunity to meet them and include them in your care plan and visits with your care team if you wish.

The Advanced Care at Home program is covered by most insurance like any hospital stay. Standard copayments, coinsurance, network restrictions and deductibles apply. Our team works with your primary care provider and any specialists you see as an outpatient to update them on your hospitalization at home.

Dr. Bosch: On your last day of hospitalization at home, you will meet with your care team to go over your medications and any instructions for your ongoing care after your hospital-at-home discharge. At that time, we will pack up the technology delivered to your home and take it with us.

Thank you for taking the time to better understand the Advanced Care at Home program at Mayo Clinic, where the needs of our patients come first. This program allows us to come directly to you and provide Mayo Clinic-level hospital care in the comfort of your own home.

[MUSIC PLAYING]

[MUSIC PLAYING]

Michael J. Maniaci, M.D., Chief Clinical Officer, Hospital Internal Medicine, Physician Lead, Advanced Care at Home, Mayo Clinic in Florida: Mr. Jolly is a gentleman with acute kidney injury. Monitoring is very important with these patients. Usually hospital stays on this or at least three to five days sometimes longer depending on the kidney function. He was 48 hours into his hospital stay and he was feeling quite fine. He asked is there any other way to do this. We said guess what we have a way. We have our Advanced Care at Home program opening up. Advanced Care at Home is taking what we do in the inpatient setting and transforming that and bringing the care to the patient in their home. We're able to transport with Mayo Clinic transport the patient out of the hospital setting into their home environment. We meet them with an APP and a tech pack. The tech pack contains everything we need to take care of that patient over the acute phase of care that includes connected, secure, HIPPA-compliant wi-fi monitoring for blood pressure, pulse ox, a scale, any other medical supplies they need along with the tablet that provides the virtual connection to us as well as a daily schedule so the patient knows exactly what's happening from time to time. We set that all up in the house and connect it. We test it. Our hands on the ground, EMS or APP staff, does a physical exam. Make sure the transfer was safe. I connect in. Talk to the patient to make sure that he's doing well and that's what we did for Mr. Jolly.

Background discussion: Dr. Maniaci to Mr. Jolly: Keeping your fluids up as you're doing is important and if the number gets a little worse that just means we need to give you more fluid that way.

Mr. John Jolly, patient: You're monitored as if you're in a hospital. For example they actually see you take the medicine and they can verify it. I think the best part of it is during the day, they've taught me how to do my blood pressure and oxygen in the blood and stuff like that so I get my own vitals and send it to them. But also if it's important enough where I know that with the thing is 24 hours a day. All I have to do is push a button and there's a picture of a nice young lady and I can start asking her questions at two o'clock in the morning or three o'clock in the morning.

Letty Jolly: Plus your mobility is much better too.

Mr. Jolly: Yeah, I think that was the worst thing about being in a hospital, I could not get up out of the bed and take a walk. I just love the idea that I can read and then I can get out and look at my marsh view. It's just so much better to be home.

Dr. Maniaci: We have the resources now to treat our patients better. To give them equal if not better care. To provide better satisfaction in their home environment and reduce costs to our patient and ourselves. It's the next evolution of medicine and we should all be part of this and striving for this, and what's after this.

Mr. Jolly: I think the big thing about this is the word, I would say, is it gives me a patient freedom.

[MUSIC PLAYING]