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Personalized Clinical Decision Support to Improve Participation in Hospital at Home

Award Number: R21HS027248
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 06/15/2021
PERIOD OF PERFORMANCE END DATE: 05/31/2023

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Personalized Clinical Decision Support to Improve Participation in Hospital at Home - PROJECT SUMMARY Inpatient hospitalization is costly – accounting for $1.1 trillion in health care spending annually in the United States – and is associated with high morbidity and mortality risks. Hospital at Home (HaH) is an alternative care model where care teams provide acute hospital-level care in a patient’s home. Despite decades of data that support HaH efficacy relevant to key patient-centered outcomes, barriers to HaH participation limit its widespread adoption and population health impact. Our central hypothesis is that providers and patients require Clinical Decision Support (CDS) integrating data from disparate sources and a Shared Decision Making (SDM) framework to help inform point-of-care decisions regarding HaH and surmount low participation rates. The overarching goal of our work is to improve value-driven care by helping patients engage in the decision of which acute-level care option best meets their needs. The objective of this study is to evaluate whether a Health Information Technology (IT)-enabled SDM solution incorporating expected patient outcomes and preferences and deployed at the point-of-care improves patient and provider participation in HaH as a care model. To achieve this objective, we will: 1) characterize patient, caregiver, and provider perceptions of the risk tradeoffs, needs, and care preferences for HaH; 2) partner with patients, caregivers, and providers to iteratively design Hospital-level Outpatient Management Evaluation and Decision Support (HOME-DS), a Health IT- enabled SDM solution that incorporates risk-model probabilities and patient and caregiver preferences; and 3) evaluate the feasibility of implementing HOME-DS in acute care and establish the acceptance rate of HaH. We will focus HOME-DS on adults aged 18 and older hospitalized with suspected pneumonia, a prevelant condition that has been commonly included in HaH models. We will apply the previously validated and broadly accepted Pneumonia Severity Index (PSI) as the quantitative risk score input for HOME-DS. User personas and needs for the initial HOME-DS prototype will be defined through key informant interviews with patients hospitalized with pneumonia, their caregivers, and providers (Aim1); user-centric design principles will further guide iterative development of the HOME-DS prototype (Aim 2); and we will test the feasibility of implementing HOME-DS in acute care to guide patient and caregiver decision making in selecting hospital level care in the home or traditional hospital (Aim 3). We hypothesize HOME-DS is feasible to implement within the provider workflow for hospital admission and can yield participation rates in HaH of 50%. The proposed project will engage a heterogeneous population with pneumonia, as this is a population with substantial acute care utilization costs and a large gap in understanding implementation challenges to explain why alternatives to traditional hospitalization are not used more widely. Results will demonstrate the value of Health IT that integrates clinical data with patient preferences to promote effective SDM enhancing patient-centered acute care options.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = -$2,639 )
2024	2022	THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY	1000 BLYTHE BLVD	CHARLOTTE	NC	28203	MECKLENBURG	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	10/5/2023	NON-COMPETING CONTINUATION	-$2,639
														Subtotal = -$2,639

Issue Date FY: 2022 ( Subtotal = $101,781 )
2022	2022	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, THE	1000 BLYTHE BOULEVARD	CHARLOTTE	NC	28203	MECKLENBURG	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	4/20/2022	NON-COMPETING CONTINUATION	$101,781
2022	2021	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, THE	1000 BLYTHE BOULEVARD	CHARLOTTE	NC	28203	MECKLENBURG	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	4/11/2022	NEW	$0
														Subtotal = $101,781

Issue Date FY: 2021 ( Subtotal = $183,205 )
2021	2021	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, THE	1000 BLYTHE BOULEVARD	CHARLOTTE	NC	28203	MECKLENBURG	USA	Research on Healthcare Costs, Quality and Outcomes	001	1	9/16/2021	NEW	$0
2021	2021	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, THE	1000 BLYTHE BOULEVARD	CHARLOTTE	NC	28203	MECKLENBURG	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	6/14/2021	NEW	$183,205
														Subtotal = $183,205

Grand Total All Awards = $282,347

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Personalized Clinical Decision Support to Improve Participation in Hospital at Home

Award Number: R21HS027248

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 06/15/2021

PERIOD OF PERFORMANCE END DATE: 05/31/2023

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