Historically, healthcare services were primarily delivered in the home, where doctors and nurses would visit their patients on house calls. With the rise of modern medicine, specialised clinics and hospitals replaced this, hospitals could house expensive technology and accommodate large numbers of patients seeking healthcare.
However, with the rising cost of providing healthcare in hospitals, we are starting to see a shift back to home-based care. As hospitals struggle to keep up with the overflow of patients every week, the solution lies in the question, what can we do to keep patients out of hospital?
A recent article by TIME magazine describes the huge strain on U.S. hospital resources, due to the worst flu season in 15 years. As this severe strain of flu moves to other countries around the globe, it is likely to create the same effect of overflowing hospital patients. This creates enormous pressure on hospital staff, resources and the entire health system. Now more than ever is it time to embrace distributed healthcare?
Distributed healthcare is the concept of providing decentralised care services, like monitoring vital signs and diagnostic tests, and moving these services closer to the person in need. This helps a healthcare system to keep people in their own homes, by providing the right care and support at the right time. Home-based healthcare services focus on providing hospital level care, in the patient’s home with the ability to provide wound care, intravenous or medical nutrition therapy, and monitoring of serious illness.
By moving services into a person’s home, distributed healthcare has the potential to improve quality, reduce costs and enhance the experience for the person receiving the care.
Current home-based healthcare provides greater convenience and satisfaction for patients, particularly for older and less mobile patients. There are existing programs that focus on patients suffering from chronic illness, where interdisciplinary teams visit the home, perform diagnostics and encourage compliance with treatment protocols. The aim is to monitor the patient and identify any exacerbation in their condition, then proactively manage the patient to prevent any future hospitalisations.
These interdisciplinary teams provide coordinated care to the patient, identify problems and gaps that can be resolved, and involve the patient and their family in communications. These home-based healthcare programs help the patient and their family to have a better understanding of their health by putting the patient at the centre of their own care.
In order for distributed care to become the new model for healthcare, it requires the technology to allow care providers and teams to connect, communicate and coordinate. The fundamental requirement for distributed care is a data platform that can integrate information from different systems and present a holistic, electronic medical record for a patient.
This workflow needs to enable the team to work together across care settings, and to include the person and their family as a key part of the care team from within the home.
Being able to view a secure shared care record allows timely, safe and informed decision–making to occur, for and with the patient. A study from Canterbury District Health Board on an integrated person-centred healthcare outlines their journey to provide an integrated, person-centred health system that crosses the boundaries between primary, community and hospital-based care.
Canterbury has developed a region-wide program to prevent acute admissions to hospital. It is designed to meet the needs of all people who would otherwise be referred to hospital but who can be safely managed in the community. Canterbury DHB’s vision is of an integrated health system that keeps people healthy and well in their own homes, providing the right care and support, to the right person, at the right time and in the right place.
Canterbury DHB is redefining the future of healthcare and providing a new model of care based around the patient rather than the provider with Shared Care Planning. This is a consolidation of multiple technology solutions that enable the delivery of patient care closer to home. It is transforming the way healthcare is delivered, by providing this care in the community, it reduces the load on acute care delivery and facilitates efficiencies in care delivery within hospitals. It is effectively keeping patients out of hospital and in their own homes, where they would rather be.
An excellent example of Shared Care Planning, is the Advance Care Plan via the HealthOne electronic medical record. This enables a competent person to think about, discuss with their families and primary care clinicians, their wishes concerning the medical care and treatment they want to receive in the future. Because this information is stored electronically, it gives family members and healthcare professionals accessible and up to date information on the patient’s medical records and their wishes for how they would like to be cared for at the end of their life, breaking down communication barriers and reducing stress, when the patient can no longer make decisions for themselves.
Since September 2014, when the initial data was collected, the majority of all patients with an Advance Care Plan have been able to die in their preferred place, with current results showing only 18% dying in hospital.
David Meates – CEO, Canterbury District Health Board said of the Advanced Care Plan “This is a New Zealand first, and possibly a global first, as we strive to ensure a strong patient voice throughout the continuum of health care in Canterbury.”
So now more than ever, it is time to embrace distributed healthcare.
To learn more about Canterbury DHB innovative Advance Care Plans, read the case study below.