Innovative hospital-at-home model boosts physician engagement

Change management techniques centered on peer-to-peer engagement had the strongest effect on increasing physician participation in Kaiser Permanente’s innovative hospital-at-home program, according to new original research published in The Permanente Journal.  

The findings from authors Arsheeya Mashaw, MD, Helen Byelyakova, and Danielle Desrochers, MD, showed that nearly 71% of respondents were “very comfortable or comfortable” with implementing changes in clinical practice in 2022 — up from 63.6% pre-COVID. 80% of responding physicians indicated they were “very comfortable or comfortable” with referring or admitting patients to the hospital-at-home program in 2023, as compared with 50% by the end of 2020. 

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Various change management initiatives, including peer-to-peer engagement, proof of quality, and patient feedback, helped pave the way toward increased comfort and confidence in the program. The results of this study reveal the shift in attitudes among physicians in embracing the benefits of telehealth and signals the adoption of home-based advanced care as part of the broader landscape of health care innovation.  

 Advanced care at home is a clinical model that delivers hospital-level care in a patient’s home. Components of this innovative program for patients with certain medical conditions include medical equipment, prescription delivery, transportation assistance, and around-the-clock clinical care. The ability to receive hospital-level care from the comfort of home can reduce health disparities and eliminate barriers to access that might otherwise keep patients from getting the care they need. Care team members can monitor patients’ progress closely, providing necessary support for diagnostic imaging, wound care, and more. Patients often avoid the need for a hospital stay.  

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Mashaw and colleagues recruited 78 emergency departments and 79 hospitalist physicians to take part in the qualitative, mixed-methods, retrospective study. They measured changing attitudes toward the hospital-at-home program (called Kaiser Permanente Care at Home) during the initial survey period, which ran from December 2021 to January 2022. Once complete, the authors facilitated additional semi-structured individual 20-minute interviews to 12 of the initial respondents.  

You can access the full article, “Implementing Systemwide Physician Change Management in an Integrated Health Care Setting: Improving Physician Participation in an Advanced Care at Home Model,” in The Permanente Journal.