Posted on | October 21, 2010 | No Comments
Steven H. Landers MD, MPH
Source: NEJM. October 20, 2010. http://www.nejm.org/doi/full/10.1056/NEJMp1000401?query=TOC#t=article
In Albuquerque, New Mexico, and Buffalo, New York,1 acutely ill patients have been sent out of the emergency department for hospital-like care at home. In Baton Rouge, Louisiana, and Little Rock, Arkansas, home health agencies provide chronic care management services, emphasizing care coordination and support for patients’ management of their own conditions. In San Diego, California, physicians arrive at patients’ homes with a new version of the black bag that includes a mobile x-ray machine and a device that can perform more than 20 laboratory tests at the point of care. Several engineering and electronics companies have developed products for monitoring health at home. Massachusetts General Hospital in Boston is experimenting with Internet videoconferencing to permit virtual visits from patients’ homes.
In my Cleveland Clinic practice, I work in my patients’ homes, using a cellular broadband connection to the same electronic record system used by my colleagues in offices and hospitals. I learn practical information about my patients’ medications, management of chronic illnesses, and nutrition and check in on how their caregivers are coping. Patients often see the home visit as a gesture of caring, and many of my older patients express nostalgia for an era when house calls were common. Hundreds of other U.S. physicians are also emphasizing home-based care, many of them now as members of the American Academy of Home Care Physicians.
In the past century, health care became highly concentrated in hospitals, clinics, and other facilities. But I believe that the venue of care for the future is the patient’s home, where clinicians can combine old-fashioned sensibilities and caring with the application of new technologies to respond to major demographic, epidemiologic, and health care trends. Five major forces are driving health care into the home: the aging of the U.S. population, epidemics of chronic diseases, technological advances, health care consumerism, and rapidly escalating health care costs.