By Liz Carey for The Daily Yonder.
Broadcast version by Jonah Chester for Illinois News Connection reporting for The Daily Yonder-Public News Service Collaboration

For rural residents, just getting to the hospital during an illness can be a struggle.

A new trial of home-based hospital care may be a solution to that, officials think.

Called the Rural Home Hospital, Ariadne Labs developed the system to deliver home hospital principles to rural communities.

Mary Frances Barthel, M.D., chief quality and safety officer at Blessing Health System in Quincy, Illinois, runs the Rural Home Hospital program there. Covering a three-state area (Illinois, Missouri and Iowa), Blessing Health includes three hospitals, two physician groups, an accredited college of nursing and health sciences, and a network of medical specialty businesses. Barthel said the healthcare system provides services for about 100,000 people.

In February, Blessing Health started a three-year study of the home-based system. Based on a successful urban home hospital program at Brigham and Women's Hospital in Boston, this trial will determine whether or not it can be applied to rural settings, Barthel said.

Just three patients have entered into the randomized study so far. Two of those patients were selected to stay in the hospital. One was selected to receive at-home care.

To enter into the program, a patient has to be admitted to the emergency department and then diagnosed with something that would normally require hospitalization to treat - like heart failure, chronic obstructive pulmonary disease, asthma, gout, chronic kidney disease, or diverticulitis. Once a patient has agreed to participate, they're randomly selected to either stay in the hospital or be treated at home.

Those that are selected to be treated at home are discharged with a nurse who goes with them and sets up the necessary equipment in their house.

"They're put on a monitor that gives us their vital statistics like blood pressure, blood oxygen... that information is available to me 24 hours a day, seven days a week," Barthel said.

Patients are also connected to the doctor through telehealth visits. The nurse visits the patient in person twice a day, and Barthel checks in on them once a day via telehealth. Patients can also contact the nurse or doctor for telehealth visits if they have questions or concerns. In some cases, the monitor will connect with the doctor to alert them if things aren't right.

"If there's a change in their vital statistics, an alert will come across an app on my phone," she said.

The system also alerts her if the monitoring equipment goes offline.

"We had an incident where the patient's tablet went to sleep," she said. "I got a notification on my phone and worked the patient through making sure the device didn't turn off."

The program frees up beds for more critically ill patients and ensures the patient can access the care.

"Transportation (to the hospital) is such an issue in rural areas, especially for our elderly patients," Barthel said.

Research shows that home hospital programs tend to have higher patient satisfaction, lower readmission rates, and a reduced risk of getting hospital-acquired complications. Barthel said so far patients have reported that the program is beneficial.

"Patients reported getting up more and moving around more," she said. "We also noticed they were more compliant with their medications and that they slept better."

The program is not without its challenges, however. Barthel said some patients who were approached to join the study declined.

"They had an expectation that when they felt sick, that they were going to have people take care of them, and that they would be better when they left the hospital," she said. "We are very careful about which patients we're including. These patients did not want to go home to treat themselves."

Another issue, she said, is internet access. The hospital has developed several strategies to ensure patients have a fast enough connection for a telehealth visit, including installing a new connection.

Another obstacle is staffing. Two in-home visits a day requires a significant amount of nursing capacity.

But advocates see the program as a way to reduce healthcare disparities for rural residents.

"Access to high-value acute care services in rural communities is a growing national problem," David Levine, M.D., leader of Ariadne Lab's RHH team, said. "A randomized controlled trial will help us examine how we can provide a high quality and safe patient experience affordably in a rural context."

Blessing is one of only two American rural hospital systems to run the trial. The other, Appalachian Regional Healthcare (ARH), provides services for rural Eastern Kentucky and southern West Virginia.

Between now and the end of the study in 2025, Barthel said she hopes to sustain an average patient population of four, with new patients entering the program and ones who have recovered being released.

"Past the trial stage, we hope to be able to replicate the program with staff deployed in each of our hospitals," she said. "Our goal is to have these services available from each of our facilities."

Liz Carey wrote this article for The Daily Yonder.


get more stories like this via email

After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


get more stories like this via email

New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.