Oct. 06, 2022
Like many health care systems, Mayo Clinic in Jacksonville, Florida, made adjustments at the height of the COVID-19 pandemic. One model that proved both beneficial and sustainable beyond pandemic-related challenges is Mayo Clinic's Advanced Care at Home.
The model is designed to improve quality of life by replicating hospital-quality complex care in a patient's home. At the time it was introduced, it allowed acutely ill patients who couldn't travel the opportunity to continue receiving high-quality care. Now, having treated more than 3,000 patients with virtual, high-acuity services including more than 1,400 patients within the Advanced Care at Home model, it provides improved access to care not only for the lower acuity patients being seen at home, but for the medically complex patients who need to be seen in the hospital setting.
"We can really reduce inpatient stay," said Roxana S. Dronca, M.D., a hematologist and oncologist and director of Mayo Clinic Comprehensive Cancer Center in Jacksonville, Florida. "We can leverage all the clinical care that can be done in the brick and mortar hospital along with digital capabilities to provide the same level of care in the patient's home."
Patients seen in the Advanced Care at Home model have had lower mortality than those in the hospital for comparable or even higher acuity. Patient acceptance is in the 96th percentile. Some patients with cancer, specifically those post-treatment from bone marrow transplant (BMT), have been included. This has led Dr. Dronca and her colleagues to plan ways in which the model can be tailored to patients with cancer.
The Advanced Care at Home model
Advanced Care at Home utilizes a command center located at Mayo Clinic that includes advanced practice providers, hospitalists, nurses and a paramedic network. Supplies are provided to the patients in their homes through collaboration with Medically Home.
Staff in the command center direct each episode of care in the home and coordinate with a nurse who is on-site with the patient. Each episode of care at home is detailed in the patient's medical record. When they return to the hospital, their usual care team can take over without missing a beat.
"The command center in Florida has expanded tremendously since the program started," said Dr. Dronca. "It's a full array of support that is available for the patients that are currently enrolled."
Because of the supply network, the initial geography included patients who lived within 30 miles of Mayo Clinic's Jacksonville location. Select patients living outside of that area could be seen using a Care Hotel, meaning their Advanced Care at Home model was set up in a hotel or extended stay facility such as Hope Lodge. More than 1,600 patients have been treated with this addition to the virtual platform.
Extended to patients with cancer
For patients using this model for post-BMT care, staff in the command center consulted with cancer specialists leading Mayo Clinic Comprehensive Cancer Center to consider how a hybrid model might work in cancer care. Dr. Dronca points out that for patients with cancer, up to 10% of their time can be spent in medical facilities at recurrent appointments for therapies and scans.
"We thought about the patients with cancer and how much of their time is spent in our medical facilities," said Dr. Dronca. "In some patients with stage 4 disease, a substantial amount of their remaining survival time is spent in medical facilities or traveling to and from."
There are several benefits to a model that allows some of a person's care journey to be done in the comfort of their own home.
- Improved quality of life for patients
- Increased time spent at home
- More efficient use of medical staff and space
Cancer care teams have continued to conduct post-BMT care in this way, and more indications and therapies are being planned.
The future holds Cancer Care Beyond Walls
The cancer center has been able to leverage the promising results in both safety and efficacy to plan and begin implementing Cancer Care Beyond Walls.
"As we roll out the cancer care, there's going to be considerations we have to make," said Dr. Dronca.
Considerations include pharmacy and insurance support, supplies, and deciding what level of care can be provided. The model requires a larger financial burden up front, but ultimately is designed to be more affordable for the health care system and the patient long term.
The Cancer Center has been awarded two grants to continue this work from the U.S. Department of Defense and a private foundation. These grant opportunities will allow Mayo Clinic Comprehensive Cancer Center to conduct a formal clinical trial within the model to measure efficacy, safety and patient satisfaction specifically in at-home cancer care and to evaluate its use going forward.
For more information
Refer a patient to Mayo Clinic.