Evaluation of Hospital-at-Home in Response to COVID-19 Pandemic
During the COVID-19 pandemic, there is an increased need to rapidly develop new models of inpatient care to address the demand for hospital beds during surge episodes. Standing up freestanding inpatient units outside of hospitals has been met with limited success, and in general can only accommodate low acuity patients, with minimal mild disease and limited monitoring and assistance. Providing inpatient level care in one’s house (hospital-at-home) to a subset of patients has been a concept recently developed and demonstrated to be effective and safe in several small randomized trials, but has not had the necessary stakeholder buy in by patients, their families, or their providers to expand to broader use or for more high acuity cases. Given the current interest on the part of patients to receive as much care as possible locally, due to fears of COVID19, this is an ideal opportunity to evaluate the implementation of hospital-at-home for high acuity inpatient care. Tufts Medical Center has partnered with a company, Medically Home, to provide hospital at home high acuity (levels II and III) inpatient level care to qualifying patients from either the emergency department or the inpatient service. This program was launched on March 31, 2020 with a small but sustained transition of patients to this model of care. The COVID-19 pandemic offers the opportunity to conduct a formal implementation evaluation of a hospital-at-home program. This includes evaluation of outcomes of care and complications of care, and implementation facilitators and barriers. We propose a pilot analysis of the findings from patients at Tufts Medical Center to inform a larger multi-site analysis of this hospital-at-home program.
Disparities in Testing and Diagnosis of COVID-19 among Tufts Medical Center Employees
The COVID-19 pandemic is shining a powerful spotlight on pre-existing health disparities. Black and Latinx people in the United States are overrepresented in COVID-19 diagnoses and deaths. The increased mortality in minority communities is a result of decades of structural racism. Racist policies and practices have led to disinvestment in community infrastructure and public health for people of color. The long-term consequences have resulted in higher prevalence of chronic illnesses like obesity and diabetes, less access to healthcare, increased reliance on public transportation, and higher rates of employment at hourly-waged jobs. At the natural interface between the hospital and community, healthcare workers are particularly high risk for transmission of COVID-19 infection. Tufts Medical Center represents a socioeconomic microcosm, with a hierarchical mapping of higher salaries for predominantly-white physicians, nurses and administrators, and lower salaries for a population of racially and socioeconomically diverse people who work in various jobs integral to the function of the hospital, including but not limited to technicians, administrative staff, food services, housekeeping and transportation. Tufts MC was one of the first hospitals in Boston to offer in house rapid COVID-19 testing, and one of the only hospitals in Boston to make testing available to all staff. There are still unanswered questions about the relative role that socioeconomic status plays in exposure to the disease. The cohort of Tufts MC and Tufts MC Physicians Organization (Tufts MC PO) employees thereby provides unique opportunity to interrogate the impact of sociodemographic impact on COVID-related care for front-line healthcare workers with access to COVID-19 testing.