Moving Care Into the Home During COVID-19 BY M I C H A E L L E , M D
When I finished training and became a hospitalist over 20 years ago, it was still a fairly new field. Patients were confused about my role and why their primary care physician wasn’t coming to see them in the hospital. Since then, hospitalists have redefined the standard of care due to superior outcomes. They are now the expected model of care for any patient in the acute care setting. Landmark’s physicians and home-based care model have similar potential—to elevate standards of care and quality of life for patients with chronic illnesses.
“
We’ve removed the exposure risk of the acute care setting for those patients who don’t absolutely need to be there.”
Landmark is a physician-led medical group supported by a full team of nursing, pharmacy, nutrition, behavioral, palliative care, and social service specialists. Founded in 2013, we were one of the early mobile medical groups to break through the barrier of traditional healthcare models and provide patients with high-level medical care in the home, whenever they need it. Through regular in-home visits and 24/7 response for urgent needs, we assess environmental factors, manage medications, increase quality of life, and extend life for patients, giving them more healthy days at home. Our team is showing up at an inflexion point in our society. Life expectancies are increasing, and by 2030, it’s estimated there will only be four potential family caregivers between the ages of 45 and 64 for every person over 80 likely to need care. That’s down from seven in 2010.1 These are the family members who often make it possible for elderly patients to stay at home and avoid assisted living facilities longer. Landmark fills that gap, and then some.
STAY HOME TO STAY ALIVE There is no greater test to a healthcare model than a public health emergency. And while the coronavirus pandemic has resulted in over 700,000 deaths nationwide, Landmark’s approach has saved lives. Stay home to stay alive was the stark reality for our patients, who average around 77 years old, take an average of 12 medications, and struggle with behavioral health, social determinants, and multiple chronic conditions. By coming to them, we helped our patients stay healthy at home. As a result, Landmark patients have seen a lower mortality rate compared with similar patient cohorts. We attribute these positive outcomes to keeping our patients out of other care settings, where the risk of coronavirus exposure—and other threats to their health— was higher. Let’s not forget that before this pandemic, the healthcare system was trying to right the ship of patient safety and infection control. Those risks beyond COVID-19 continue to wait in acute care settings—and may be even worse. Recently, the Centers for Disease Control and Prevention published a new analysis showing that responding to the pandemic has set these goals even further out of reach. In 2020, there were significant increases in bloodstream and urinary tract infections and ventilator-acquired pneumonia across hospitals, urgent care centers, and outpatient facilities.2
36 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Fall/Winter 2021
