Nemours launches program to expand care at home

Over the past several months, Nemours Children’s Health has launched a new model to serve pediatric patients with complex needs.

Nemours calls it “Advanced Care at Home,” and the program connects families to the health system via telehealth. The pediatric health system says it’s not a hospital-at-home program, since it’s not acute care.

But the program offers a safety net for children and babies with complex conditions, allowing them to recover at home in a more familiar environment. Families in the program can connect with nurses via telehealth around the clock. 

Jane Mericle, chief nursing executive and patient operations officer of Nemours Children's Health, tells Chief Healthcare Executive® that she’s encouraged by the early success of the program. She says it is “a new model” of care.

“It’s a full virtual model,” Mericle says. “So it's a virtual, 24/7, technology-enabled model for us to really bridge our kids from the hospital into the home.

“And what we're finding is by having this virtual model, where you have virtual nurses that can call in and talk to families, reinforce support. We have telehealth visits from our providers and our physicians and APPs …. We also have on demand so a family can reach out to us, and we can get with them right away.”

(See part of our conversation in this video. The story continues below.)

Could change ‘standard of care’

So far, Nemours has enrolled more than 100 patients in the program. Nemours rolled out the program in Florida in June, and the system has recently expanded it into Delaware.

Mericle says the program can be tailored for the needs of children and families. In the first week after a hospital discharge, virtual visits may take place once a day. For those patients that are more stable, the visits can be weekly.

“We're really customizing it according to what we think that the kids and the families need,” Mericle says.

So far, the program appears to be helping Nemours discharge patients to the home more quickly, and the virtual program is helping family avoid trips to the emergency room that may not be needed.

“What we're finding is that not only are we getting the children out of the home sooner, we are preventing readmissions,” she says. “Our families are more confident.”

Typically, when patients aren’t sure if they need to go back to the hospital, they have opted to go to the emergency room just in case. “Because what families will tell us is that sometimes, when they get concerned, it's just too worrisome, and they'll go to the ED,” she says.

But the virtual care program is helping avoid some of those rushed trips to the emergency department, which are stressful for families in many ways.

“The thing that we don't always think about with our children and our families is really that burden of care,” Mericle says. “So how far do they have to drive to the hospital for an appointment or go to the ED. How much work is missed, how much school is missed, how are the siblings impacted?”

Mericle says she thinks the program “could change the standard of care for our kids, because it really does bridge that time between the hospital and then getting them back once the children are more stabilized.

“Then we can also hand them right back into their primary care practice, and help bridge that as well,” she adds.

• Read more: Why Nemours is helping a Delaware neighborhood

‘A lot more normalcy’

Many of Nemours’ patients have complex care needs, and they can remain in the program for weeks to offer extra support to patients and their families. She says Nemours is talking with insurers about new payer models to help support the program.

“It really is becoming a piece of the puzzle of that whole continuum of care, and so when it's right for that child and the family, then we can make it happen,” Mericle says.

There are many advantages for patients - and their families - in finding a way to discharge a little earlier, with some help.

“They're eating their own food,” Mericle says. “They're in their own environment. They're with their pets. It's a lot more normalcy, and we think that it's a much better way for our kids to heal and transition.”

“Here's our bottom line philosophy, if a child can be cared for in a home, they should be cared for in a home. That is our primary goal. And so to be able to do that is huge, because … it's the right thing to do for the children. It's the right thing to do for the family.”

Mericle points out discharging patients earlier and getting them extra care at home can lower the cost for families.

The program also enables Nemours to provide beds for patients who need to be in the hospital.

“It creates capacity for other children that need to be within the hospital walls,” Mericle says.

• Read more: Nemours Children’s Health CEO talks about improving the health of kids, and everyone else