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Published on November 17, 2020

As Midwest Cases Surge, Avera Reduces COVID-19 Hospitalizations Through Home Care

Demand for home care has grown with more consumer preferring care in the comfort of their own homes. Avera Health brought together elements of home care, telehealth and a 24-hour hotline to reduce hospitalizations due to COVID-19, even as cases are surging across the Midwest.

“We have treated 3,000 patients through our Avera@Home COVID Care Transitions program, which is far more patients in home care than in our hospitals,” said Chad Thury, DO, Medical Director of Avera@Home. “This preserves hospital resources, like staffing and supplies, for the sickest patients. Because hospital resources can become severely taxed during a surge in cases, we feel this model can help our nation’s health systems navigate more successfully through this pandemic.”

“Among 3,000 COVID-19 patients seen between early April and mid-November, we have been successful in preventing hospitalizations and achieving a hospitalization rate of approximately 5.3% – significantly less than Avera’s models had predicted,” said Rhonda Wiering, Vice President, Clinical Growth and Innovation for Avera@Home.

As an example, on a recent date, Care Transitions was caring for 1,142 patients at home, 159 of whom were on oxygen. “In most cases, these 159 patients would have been hospitalized. Among these moderately and severely ill patients, we are seeing success in keeping them out of the hospital, yet we are also monitoring them in order to get them hospital care at the right time, when intervention is needed,” Wiering said

Avera, based in Sioux Falls, S.D., saw its first diagnosed cases March 10, 2020.

By March 11, Avera had launched a 24-hour COVID-19 Hotline that patients could call for information on testing and treatment. “At that time, our region had relatively few cases, but no one knew what to expect from this novel virus that was causing such severe illness overseas and elsewhere in the United States,” said Kevin Post, DO, Chief Medical Officer for Avera Medical Group.

“We knew that it would not be safe for staff or other patients for people to begin showing up at their local clinic with possible COVID symptoms,” Post said. “We immediately came out with communications directing people to call the hotline first. The design of the hotline was to triage patients, determine if testing was required, and then direct patients to an appropriate testing center.”

Patients who test positive, have COVID-19 symptoms and are at high risk can be referred to the Avera@Home COVID Care Transitions program. These patients receive regular phone or video nurse calls and telehealth equipment. Avera@Home also delivers an at-home monitoring kit to the patient’s house. The kit allows the patient to monitor their oxygen levels, blood pressure, temperature and COVID symptoms, with all data transmitted instantly to the care team.

The Care Transitions team uses a variety of treatments and interventions to help patients cope with COVID-19 symptoms, from over-the-counter medications and humidifiers for cough and gastrointestinal distress, to cold packs for fever, lung exercises and the use of fans for shortness of breath, use of steroids and inhalers/nebulizers, and instruction on prone positioning. Experienced nurses are supported by internal medicine physicians. “While working closely with internal medicine physicians, this team is providing virtual care all day, every day for COVID patients. They’ve gotten very good at anticipating what patients need,” Wiering said.

“Getting a COVID diagnosis is scary. Many of our patients feel a great deal of anxiety, which we can address with support and encouragement. The daily contacts are very reassuring,” Wiering said. Addressing anxiety and concerns of patients by phone or video visit often prevents emergency room visits.

“Of course, there are absolutely those patients who need hospitalization and we follow best practices in determining the right course of care and treatment. But when it’s possible, most patients want to recover at home, and we are able to give them the tools to make this happen in the majority of cases,” Wiering said.

Over one-fourth, or 26% of COVID-19 patients, spoke 18 languages besides English – with 15% having Spanish as their first language. Avera@Home uses a language line to provide interpretation services.

Avera’s program is unique in that it is more extensive than most home support programs for COVID patients. “Avera was able to stand all of this up very quickly because we had a 24-hour medical call center in place. We had an expanded Care Transitions program in place. And, we had Avera eCARE® – a world-class telemedicine program in place and 25 years of telemedicine experience,” Thury said.

Avera@Home Care Transitions has existed for eight years. The program’s goal is to reduce hospital readmissions and emergency room visits. Through phone calls and video calls, patients receive support, reassurance and education for 30 days.

“Using this framework and staff, Avera@Home was well positioned in the spring of 2020 to quickly launch a similarly designed virtual COVID-19 Home Care Transition program,” Wiering said. Similar clinical pathways were created for obstetric and pediatric patients.

Prediction models show that the current surge across the Midwest could continue for several weeks. “We are seeing increased hospitalizations across our system but also increased numbers in our at-home program,” Thury said. “It’s clear that this remains a vital element in the continuum of care for COVID-19.”

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