Home Hospitalization: innovative model revolutionizes the healthcare sector

In Brazil, a large part of the care aimed at chronic patients or those undergoing rehabilitation is carried out at home, through Home Care (HC), also known as Home Care, a type of care that has been growing exponentially in the country in recent decades.

This trend is confirmed by NEAD-FIPE Census, a survey commissioned by the National Center for Home Care Services Companies (NEAD) and carried out by the Economic Research Institute Foundation (Fipe). If in 2019 the study revealed that around 300,000 patients were cared for at home that year, in 2022 it pointed to 346,000 patients being cared for, a significant increase.

Pioneer in Home Care in the country, for almost 30 years Home Doctor sees patients at home. Throughout this period, however, the company has been reviewing its models to offer solutions that are increasingly aligned with current needs.

“The demographic transition and population aging have impacted the healthcare system. With the population living longer, in the near future both patients and their caregivers will be elderly and it will be necessary to have a larger structure, taking care outside the hospital and into the home”, explains Dr. Cláudio Flauzino, doctor and executive director from Home Doctor.

Hospitalization Home: cutting-edge technology for the benefit of the patient

Always seeking to develop innovative technologies that allow more and more patients to be treated safely at home, Home Doctor recently launched a new model of care: Home Hospitalization. “During the pandemic, home treatment gained strength and technologies emerged that did not exist until then, while others were improved. For example, remote monitoring of mechanical fans, which was rarely used, is now used on a larger scale. Teleconsultations have also evolved a lot, new platforms for scheduling and electronic medical records have emerged, among other improvements. Another aspect impacted by Covid-19 was the lack and consequent increase in the cost of supplies and the appreciation of doctors and other health professionals. All of this led to increased costs and forced us to be more efficient. And one of the escape valves for this demand for efficiency is technology”, explains Flauzino.

In this scenario, Home Doctor revisited its almost 30 years of experience in home care and questioned the areas for improvement. “We see the positive consequences of the pandemic as opportunities and study the models that work in other countries. We carried out two studies: a systematic literature review, to understand what was being done abroad, in developed countries such as Australia, England, France and the United States. We identified that while in Brazil we use more professionals at home, there they are replaced by technology, whenever possible. Another difference is that they train caregivers and family members so that they can act more effectively in caring for the patient. Based on these findings, we created a theoretical model. We selected a sample of 920 patients from Home Doctor and carried out a simulation to understand the percentage that could be cared for within home hospitalization. The result was that 70% of this studied population could be served in the model, with gains in safety, quality and technology”, says the doctor.

A more sustainable model

Flauzino remembers that 30 years ago there was no technology, there was no remote monitoring, the healthcare professional remained in the patient’s home the entire time, often remaining busy for just 2 or 3 hours. “The rest of the day there was often no need for his presence. This model is not sustainable”, highlights Flauzino.

Home Hospitalization, innovative, incorporates technology for real-time monitoring, 24 hours a day, of patients treated at home. As with all services provided by Home Doctor, an individual plan is created, specifically for that patient, and family members and caregivers receive training to actively participate and know what to do in emergency situations, such as a drop in saturation or some another incident.

“In parallel, we remotely monitor all vital signs. If there is mechanical ventilation, we control the fan. Through our command center we are fully focused on the patient at all times, monitoring data such as the frequency with which the temperature is being measured and medications are administered. And, if a very critical change occurs and the alarm goes off, emergency assistance is immediately called, there is a protocol for this. It could be an ambulance, a nurse, it depends on the level of severity”, says the executive director of Home Doctor.

Another important point of Home Hospitalization is the offer of a more efficient structure. “Service is based on the participation of professionals who we believe are the most qualified in the chain. We provide specialized doctors and nurses, more frequently, as we understand that these are the pillars for clinical care. When necessary, speech therapists, nutritionists, psychologists and physiotherapists also work. The nursing technician only goes to the residence when it is really necessary, for example to change dressings, administer intravenous medications and hygiene procedures. There is no need for on-call shifts, as the patient is under the care of the caregiver and trained family members and is monitored remotely, through technology”, highlights doctor Heloisa Gaspar, Clinical Superintendent at Home Doctor.

In this way, the model proves to be safe and efficient to serve patients in the most diverse conditions: chronic conditions, such as respiratory or neurological diseases, in which there is a need for continuous or intermittent ventilation equipment; children who have experienced perinatal complications and, eventually, present a chronic pulmonary, cardiological or neurological condition and need special attention to gain weight, control seizures or respiratory support. “These issues can persist for months until the child gains some improvement and independence. And without a doubt, children develop better at home, with family engagement and participation. Other patients with acute situations, such as post-operative or trauma, can also benefit from home hospitalization, which offers benefits such as a lower risk of infection and other adverse events, humanization in treatment, integration of the patient into the home environment and greater engagement of family members and caregivers. All of this combined with safety, real-time monitoring and monitoring by specialized professionals”, highlights the doctor.

Training for the Home Care

According to Heloísa, the technical qualification of health professionals has proven to be an important challenge. “Just like in hospitals, in home care there is a gap in professional training, a lack of specialized training”, she explains.

Therefore, in 2017 the company created the Home Doctor Teaching and Research Institute. “In a well-structured way, we provide training for both our professionals and those from other institutions. We have a distance learning platform, we offer in-person training, including simulation on mannequins, and we have 4 realistic simulation centers, in our units in São Paulo, Rio de Janeiro, Brasília and Salvador. Furthermore, we hold events periodically, such as the International Scientific Forum on Home Care, held in 2022 and 2023, aimed at the entire market”, explains the doctor.

Launched in August, the Home Hospitalization model is offered only by Home Doctor, and through a pilot system made with 5 health plans. “It’s something new, we see 2 to 3 patients per month, both adults and pediatrics. But the results have been very good, we have already seen the potential for growth”, concludes Heloísa.