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. 2023 Mar 27;23(1):287.
doi: 10.1186/s12913-023-09333-7.

Severity of illness and risk of mortality in Mayo Clinic's virtual hybrid advanced care at home program: a retrospective cohort study

Margaret R Paulson  1 , Ricardo A Torres-Guzman  2 , Francisco R Avila  2 , Karla C Maita  2 , John P Garcia  2 , Antonio J Forte  2 , Gautam V Matcha  3 , Ricardo J Pagan  3 , Michael J Maniaci  4
Affiliations

Severity of illness and risk of mortality in Mayo Clinic's virtual hybrid advanced care at home program: a retrospective cohort study

Margaret R Paulson et al. BMC Health Serv Res. .

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.

Keywords: Home hospital; Risk of mortality; Severity of illness; Telemedicine.

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Conflict of interest statement

No authors have any personal or financial conflicts of interest to declare. All authors are full-time employees of Mayo Clinic, which in turn has an ownership interest in a joint venture with Medically Home, a technology company that enables acute health care delivery provided to patients in their homes. Dr. Maniaci serves as Mayo Clinic’s representative on the Medically Home Board of Directors; this is an unpaid position. No authors have any personal financial interest Medically Home or receive any royalties through Mayo Clinic as part of the venture.

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