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Hospital in the Home visits

Researchers
#1

Hi all.

Some of our inpatients are “Hospital in the Home” meaning that they remain admitted for months and sometimes years, but they at home and come into the hospital for short periods e.g. for imaging or for intensive care in that duration. Should such HitH visits be represented as one long visit with multiple events or as a series of short visits, in which case, how should we account for the fact that they are not discharged between visits?

thank you

G

#2

Interesting. I assume that when they are at home there are under some kind of surveillance? You may want to introduce this as a new Visit, as a child to Inpatient. You could have the overall HitH as a VISIT_OCCURRENCE, and the individual encounters as VISIT_DETAIL.

#3

Great points Guy Tsafnat!

This is an important new model of care delivery. We are moving toward this model and others I know of are already using it in defined subpopulations/settings as you are or are planning to.

We need:

  • Proper representation of HitH as a distinct type of visit concept
  • A community ETLing convention
    • Maybe the one Christian implies in the suggested child relationship to the parent inpatient admission that initiates HitH care
      • Allows for algorithmic definitions of important derived data elements (length of stay and episodes of care)
      • Reflect the distinct characteristics of HitH
      • Make the derived data elements differentiable from other existing types of in-home care and subsumable with versions of those data elements defined for hospital-level care that only occurs in inpatient settings
#4

I’m unfamiliar with the Hospital in the Home visit. Is this HitH visit completely separate from the other hospital visits? Example would be the HitH is distinctly separate care from a patient perspective, not a billing/location perspective. Maybe the HitH could be described as long term care, skilled nursing care or inpatient physical rehabilitation where a person receives many healthcare services in the form of procedures (Ventilator management, wound care, iv’s or Foley catheters). And the “other hospital visits” are either short/outpatient visits for labs, imaging, consults, etc. or it could be for an inpatient stay. If this describes your HitH, I would probably create a HitH record in Visit Occurrence (VO) and then create new records in VO for the other hospital visits since the person is receiving active care in a different Visit form (outpatient, inpatient, etc.).

The Visit Detail (VD) hold details or child records of the parent VO record. So, if the HitH visit is the overarching, continuous visit and the “other hospital visits” are the visits within a visit, use the VO to hold the HitH visit and the VD to record the other hospital visits.

I like @Andrew’s idea of an “episode” of care. I think the HitH, if I understand it correctly, is at a higher, less granular level than the standard VO concepts of Inpatient, Outpatient, ED, etc. The HitH seems like it is an episode and the “other hospital visits” are at the VO level.

I’m interested to learn more!

t