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Chadha RM, Paulson MR, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Forte AJ, Matcha GV, Pagan RJ, Maniaci MJ. The ASA Classification System as a Predictive Factor to Stay at the Virtual Hybrid Care Hotel. Am Surg 2023; 89:4707-4714. [PMID: 36154300 DOI: 10.1177/00031348221129524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The Care Hotel is a virtual hybrid care model for postoperative patients after low-risk procedures which allow recovery in an outpatient environment. This study aimed to analyze if the American Society of Anesthesiologists Physical Status (ASA PS) Classification System can be used as a predictive factor for staying at Mayo Clinic's Care Hotel. METHODS This retrospective cohort study was conducted between July 23, 2020, and June 4, 2021, at Mayo Clinic in Florida, a 306-bed community academic hospital. ASA PS Class and post-procedure care setting (Care Hotel vs inpatient ward) were collected. Patients were classified into two ASA PS groups (ASA PS Classes 1-2 and 3-4). Pearson's Chi-square test was used to determine if the ASA PS Class and having stayed or not at the Care Hotel were independent and an Odds Ratio (OR) calculated. RESULTS Out of 392 surgical and procedural patients, 272 (69.39%) chose the Care Hotel and 120 (30.61%) chose the inpatient ward. There was a statistically significant association between ASA PS Class and staying at the Care Hotel, P < .01. The OR of preferring to stay at the Care Hotel in patients with ASA PS Class 1-2 vs ASA PC Class 3-4 was 1.91 (P = .0041, 95% CI: 1.229-2.982). CONCLUSION Patients with ASA PS Classes 1-2 are almost twice as likely to elect to stay at the Care Hotel compared to those with ASA PS Classes 3-4. This finding may help care teams focus their Care hotel recruitment efforts.
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Affiliation(s)
- Ryan M Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | | | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Paulson MR, Torres-Guzman RA, Avila FR, Maita KC, Garcia JP, Forte AJ, Matcha GV, Pagan RJ, Maniaci MJ. Severity of illness and risk of mortality in Mayo Clinic's virtual hybrid advanced care at home program: a retrospective cohort study. BMC Health Serv Res 2023; 23:287. [PMID: 36973689 PMCID: PMC10041490 DOI: 10.1186/s12913-023-09333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND In July 2020, Mayo Clinic launched Advanced Care at Home (ACH), a high-acuity virtual hybrid hospital-at-home model (HaH) of care at Mayo Clinic Florida and Northwest Wisconsin, an urban destination medical center and a rural community practice respectively. This study aims to describe demographic characteristics of ACH patients as well as their acuity of illness using severity of illness (SOI) and risk of mortality (ROM), to illustrate the complexity of patients in the program, taking into account the different diagnostic related groups. METHODS Mayo Clinic uses All Patient Refined-Diagnosis Related Groups (APR-DRG) to calculate SOI and ROM on hospitalized patients. APR-DRG data, including SOI and ROM, were gathered from individual chart reviews from July 6, 2020, to March 31, 2022. RESULTS Out of 923 patients discharged from ACH, the average APR-DRG SOI was 2.89 (SD 0.81) and ROM was 2.73. (SD 0.92). Mean age was 70.88 (SD 14.46) years, 54.6% were male patients and the average length of stay was 4.10 days. The most frequent diagnosis was COVID-19 infection with 162 patients (17.6%), followed by heart failure exacerbation (12.7%) and septicemia (10.9%). The 30-day readmission rate after discharge from ACH was 11.2% (n = 103) and the 30-day mortality rate was 1.8% (n = 17). There were no in-program patient deaths. CONCLUSIONS SOI and ROM from patients at the ACH program have been shown to be in the range of "moderate/major" according to the APR-DRG classification. The ACH program is capable of accepting and managing highly complex patients that require advanced therapeutic means. Furthermore, the ACH program has an in-program mortality rate of 0 to date. Therefore, ACH is rising as a capable alternative to the brick-and-mortar hospital.
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Affiliation(s)
- Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | | | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Paulson MR, Shulman EP, Dunn AN, Fazio JR, Habermann EB, Matcha GV, McCoy RG, Pagan RJ, Maniaci MJ. Implementation of a virtual and in-person hybrid hospital-at-home model in two geographically separate regions utilizing a single command center: a descriptive cohort study. BMC Health Serv Res 2023; 23:139. [PMID: 36759867 PMCID: PMC9911182 DOI: 10.1186/s12913-023-09144-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND As providers look to scale high-acuity care in the patient home setting, hospital-at-home is becoming more prevalent. The traditional model of hospital-at-home usually relies on care delivery by in-home providers, caring for patients in urban communities through academic medical centers. Our objective is to describe the process and outcomes of Mayo Clinic's Advanced Care at Home (ACH) program, a hybrid virtual and in-person hospital-at-home model combining a single, virtual provider-staffed command center with a vendor-mediated in-person medical supply chain to simultaneously deliver care to patients living near an urban hospital-at-home command center and patients living in a rural region in a different US state and time zone. METHODS A descriptive, retrospective medical records review of all patients admitted to ACH between July 6, 2020, and December 31, 2021. Patients were admitted to ACH from an urban academic medical center in Florida and a rural community hospital in Wisconsin. We collected patient volumes, age, sex, race, ethnicity, insurance type, primary hospital diagnosis, 30-day mortality rate, in-program mortality, 30-day readmission rate, rate of return to hospital during acute phase, All Patient Refined-Diagnosis Related Groups (APR-DRG) Severity of Illness (SOI), and length of stay (LOS) in both the inpatient-equivalent acute phase and post-acute equivalent restorative phase. RESULTS Six hundred and eighty-six patients were admitted to the ACH program, 408 in Florida and 278 in Wisconsin. The most common diagnosis seen were infectious pneumonia (27.0%), septicemia / bacteremia (11.5%), congestive heart failure exacerbation (11.5%), and skin and soft tissue infections (6.3%). Median LOS in the acute phase was 3 days (IQR 2-5) and median stay in the restorative phase was 22 days (IQR 11-26). In-program mortality rate was 0% and 30-day mortality was 0.6%. The mean APR-DRG SOI was 2.9 (SD 0.79) and the 30-day readmission rate was 9.7%. CONCLUSIONS The ACH hospital-at-home model was able to provide both high-acuity inpatient-level care and post-acute care to patients in their homes through a single command center to patients in urban and rural settings in two different geographical locations with favorable outcomes of low mortality and hospital readmissions.
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Affiliation(s)
- Margaret R. Paulson
- grid.414713.40000 0004 0444 0900Division of Hospital Internal Medicine, Mayo Clinic Health System, Menomonie, WI USA
| | | | - Ajani N. Dunn
- grid.417467.70000 0004 0443 9942Administrative Operations, Mayo Clinic, Jacksonville, FL USA
| | - Jacey R. Fazio
- grid.417467.70000 0004 0443 9942Administrative Operations, Mayo Clinic, Jacksonville, FL USA
| | - Elizabeth B. Habermann
- grid.66875.3a0000 0004 0459 167XHealth Care Delivery Research, Mayo Clinic, Rochester, MN USA
| | - Gautam V. Matcha
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
| | - Rozalina G. McCoy
- grid.66875.3a0000 0004 0459 167XHealth Care Delivery Research, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDivision of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN USA
| | - Ricardo J. Pagan
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
| | - Michael J. Maniaci
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
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Chadha RM, Paulson MR, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Forte AJ, Matcha GV, Pagan RJ, Maniaci MJ. A Virtual Hybrid Care Hotel Model Supports the Recovery of Post-procedural Patients with Mild to Severe Systemic Diseases. Am Surg 2022:31348221082271. [PMID: 35420494 DOI: 10.1177/00031348221082271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with mild to severe chronic systemic disease undergoing low-risk procedures are often hospitalized for observation. The Care Hotel is a novel virtual medicine hybrid model of care that offers patients a comfortable, out of hospital environment where they can receive both in-person and virtual care after a surgery or procedure. This study aimed to analyze if virtual hybrid post-procedure care in a hotel could be both conducted on and accepted by patients, even those with moderate to severe chronic diseases. METHODS This retrospective cohort study was conducted between July 23, 2020 and June 4, 2021 at Mayo Clinic in Florida, a 306-bed community academic hospital. We collected the sex, age, race, ethnicity, acceptance rate, ASA score, and primary procedure of patients using the Care Hotel. RESULTS Out of 392 patients, 272 (69.4%) opted for care in the program. Median patient age was 61.5 years, 59.56% were males, and 86.40% were white. We found that 50.37% had an ASA score of 2 and 43.4% had an ASA score of 3. Ten different surgical specialties were able to utilize the Care Hotel for care in 47 different procedure types. Urology had the most patients (n=70, 25.7%). Post-electrophysiologic procedures were the most common procedures (n=39, 14.3%). CONCLUSION Our virtual hybrid Care Hotel program was widely accepted by patients and could care for a multitude of post-operative procedures. Additionally, this novel program can care for patients with both mild and severe systemic diseases.
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Affiliation(s)
- Ryan M Chadha
- Department of Anesthesiology, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, 170021Mayo Clinic Health Systems, Eau Claire, WI, USA
| | - Francisco R Avila
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA.,Department of Neurological Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, 156400Mayo Clinic, Jacksonville, FL, USA
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Maniaci MJ, Maita K, Torres-Guzman RA, Avila FR, Garcia JP, Eldaly A, Forte AJ, Matcha GV, Pagan RJ, Paulson MR. Provider Evaluation of a Novel Virtual Hybrid Hospital at Home Model. Int J Gen Med 2022; 15:1909-1918. [PMID: 35237065 PMCID: PMC8882662 DOI: 10.2147/ijgm.s354101] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Healthcare provider’s experience with new models of care is crucial for long-term success. In July 2020, Mayo Clinic implemented a novel virtual hybrid hospital at home program called Advanced Care at Home (ACH). This model allows virtual providers in a command center to care for high-acuity patients in the home setting through collaboration with a vendor-mediated supply chain. This study aims to describe the outcomes obtained from a survey applied to the ACH providers to determine their acceptance of the quality and safety of the virtual hybrid care model, their perception towards the decision-making and teamwork between the command center and supplier network, and determine if the overall experience with ACH was rewarding. Methods A 15-question anonymous survey was distributed via email quarterly to all the physicians and nurse practitioners registered in ACH program at Mayo Clinic. The survey encompassed questions related to the overall experience in ACH concerning work environment, quality of care, service reliability, teamwork, decision-making, and satisfaction. All the questions were Likert-like scale choice, and a descriptive analysis using frequency distribution and percentages of the data was performed. Results Between September 1, 2020 and April 30, 2021, three quarterly surveys were sent to a total of 21 physicians and nurse practitioners caring for patients virtually in ACH. The response rate reported was 72%, 33%, and 66%, respectively, at the first, second, and third quarters. Eighty percent or more of providers consistently gave positive scores to all three areas analyzed throughout the 8-month study. Conclusion Providers found the ACH virtual hybrid model of home hospital care very rewarding. They were able to deliver high-quality and safe care to their patients through positive teamwork with a vendor-mediated supply chain. This novel model of hospital at home has the potential to be a great provider satisfier moving forward.
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Affiliation(s)
- Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
- Correspondence: Michael J Maniaci, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1 904-956-0081, Fax +1904-953-2848, Email
| | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Abdullah Eldaly
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
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Stancampiano FF, Palmer WC, Getz TW, Serra-Valentin NA, Sears SP, Seeger KM, Pagan RJ, Racho RG, Ray JC, Snipelisky DF, Mentel JJ, Diehl NN, Heckman MG. Rare Incidence of Ventricular Tachycardia and Torsades de Pointes in Hospitalized Patients With Prolonged QT Who Later Received Levofloxacin: A Retrospective Study. Mayo Clin Proc 2015; 90:606-12. [PMID: 25863416 DOI: 10.1016/j.mayocp.2015.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the incidence of ventricular tachycardia and ventricular fibrillation in patients with prolonged corrected QT interval (QTc) who received levofloxacin through retrospective chart review at a tertiary care teaching hospital in the United States. PATIENTS AND METHODS We selected 1004 consecutive hospitalized patients with prolonged QTc (>450 ms) between October 9, 2009 and June 12, 2012 at our institution. Levofloxacin was administered orally and/or intravenously and adjusted to renal function in the inpatient setting. The primary outcome measure was sustained ventricular tachycardia recorded electrocardiographically. RESULTS With a median time from the start of levofloxacin use to hospital discharge (or death) of 4 days (range, 1-94 days), only 2 patients (0.2%; 95% CI, 0.0%-0.7%) experienced the primary outcome of sustained ventricular tachycardia after the initiation of levofloxacin use. CONCLUSION In this study, the short-term risk for sustained ventricular tachycardia in patients with a prolonged QTc who subsequently received levofloxacin was very rare. These results suggest that levofloxacin may be a safe option in patients with prolonged QTc; however, studies with longer follow-up are needed.
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Affiliation(s)
| | - William C Palmer
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Trevor W Getz
- CRISP Investigative Research Program, Mayo Clinic, Jacksonville, FL
| | | | - Steven P Sears
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Ricardo J Pagan
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Ronald G Racho
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Jordan C Ray
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - John J Mentel
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
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