title: Program at home: a Veterans Affairs Healthcare Program to deliver hospital care in the home.
abstract: The Portland Veterans Affairs Medical Center (PVAMC) participated in a research-based National Demonstration and Evaluation Study of Hospital at Home Care for Elderly Patients. PVAMC continued hospital at home care in a modified form based on the results of that research phase and feedback from patients, families, and staff. The modified clinical program (referred to as Program @ Home) provided care for the same diagnoses (exacerbation of congestive heart failure, exacerbation of chronic obstructive pulmonary disease, community-acquired pneumonia, cellulitis) but differed from the research-based demonstration project in that it accepted patients of all ages, accepted early-discharge patients from the hospital, and provided a less-intensive physician and nursing model. In the first 42 months, 290 patients were admitted; 23% came from the emergency room, 54% were early hospital discharge, and the remainder came from an outpatient clinic or home care. Average length of stay was 3.2 days, and 37% were younger than 65. The results describe how a home hospital program has been integrated into the clinical care offerings of a managed care health system and how it supports inpatient, primary, emergency, and home care programs.
authors.affiliation: Veterans Affairs Medical Center, Portland, Oregon 97207, USA. scott.mader@va.gov
authors.forename: Scott L
authors.initials: SL
authors.lastname: Mader
authors.forename: Marijo C
authors.initials: MC
authors.lastname: Medcraft
authors.forename: Carol
authors.initials: C
authors.lastname: Joseph
authors.forename: Kay L
authors.initials: KL
authors.lastname: Jenkins
authors.forename: Nancy
authors.initials: N
authors.lastname: Benton
authors.forename: Kathleen
authors.initials: K
authors.lastname: Chapman
authors.forename: Maggie A
authors.initials: MA
authors.lastname: Donius
authors.forename: Carol
authors.initials: C
authors.lastname: Baird
authors.forename: Richard
authors.initials: R
authors.lastname: Harper
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Ansari
authors.forename: Jim A
authors.initials: JA
authors.lastname: Jackson
authors.forename: William
authors.initials: W
authors.lastname: Schutzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs