Mass General Brigham receives $4.6M to study at-home rehab

In a move that could reshape post-hospital care, the Massachusetts Executive Office of Health and Human Services (EOHHS) has granted $4.6 million to Mass General Brigham to study the effectiveness of providing short-term rehabilitation care at home compared to traditional skilled nursing facilities (SNFs).

“If successful, this care model may lead to a complete transformation of how we deliver advanced rehab care to our patients,” said David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, and principal investigator of the trial in a press release. 

“There are not enough rehab beds in Massachusetts, and if we can substitute facility-based care with home-based care, we will be able to help alleviate the capacity crisis that our healthcare systems have been experiencing across the state. This would have an immediate benefit for patients, family caregivers and clinicians.”

In the U.S. about 40% of senior patients that are discharged from acute care hospitals need post-hospital care, with approximately half receiving treatment in SNFs. However, these facilities are grappling with increasing costs, staff shortages, and capacity issues, problems that have only been exacerbated by the COVID-19 pandemic.

In Massachusetts alone, nearly 2,000 patients are currently awaiting discharge from hospitals, according to the Massachusetts Health & Hospital Association. This backlog not only prevents patients from accessing necessary rehabilitation care but also ties up acute care beds needed for new patients.

“If successful, this care model may lead to a complete transformation of how we deliver advanced rehab care to our patients,” said David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, and principal investigator of the trial in a press release. 

“There are not enough rehab beds in Massachusetts, and if we can substitute facility-based care with home-based care, we will be able to help alleviate the capacity crisis that our healthcare systems have been experiencing across the state. This would have an immediate benefit for patients, family caregivers and clinicians.”

The study will involve 300 patients from five Boston-area hospitals: Massachusetts General Hospital, Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, Boston Medical Center, and Cambridge Health Alliance. Half of these patients will receive short-term rehab care at home, while the other half will be treated in traditional SNFs.

For those assigned to home-based care, the treatment plan includes:

– Initial visits from a nurse, certified nurse assistant, physician, and home health aide

– Daily remote physician consultations

– Regular in-home certified nurse assistant visits

– Access to physical, occupational, and speech therapies as needed

– 24-hour in-home response from mobile integrated health paramedics

– Additional home health aide care when necessary

This comprehensive approach aims to replicate and potentially improve upon the care provided in SNFs. The study will also examine the experiences of family caregivers and clinical staff, assessing factors such as burden and burnout.

The current study builds on a smaller, 10-patient pilot conducted in 2019, which showed promising results in terms of lower costs and improved patient experience for home-based care. 

If successful, this study could provide a solution to the ongoing capacity crisis in healthcare systems across Massachusetts and potentially serve as a model for nationwide implementation. 

“At Mass General Brigham, we are leaders in the advanced home-based care space. One of our goals is to create the evidence base that will be a pathway for the country’s healthcare systems to follow nationwide,” Dr. Levine shared. 

The results could have far-reaching implications for patients, caregivers, and healthcare systems, potentially leading to more efficient, cost-effective, and patient-centered rehabilitation services.