Could we bring the hospital to the home?
In a world grappling with overcrowded hospitals, Malaysia, much like other nations, is at a pivotal juncture in healthcare.

Patients waiting for hours, even days, for a hospital bed has become a pressing issue – one that affects both public and private healthcare institutions.

But this is not a problem unique to Malaysia; countries like the United Kingdom and the United States also grapple with bed shortages.

In this landscape, the need for a significant transformation in healthcare delivery has become increasingly evident.

“Hospital in the home”, an approach that gained momentum during the Covid-19 pandemic, offers a promising solution to address the problem of overcrowded hospitals.

Covid-19 was the catalyst

The Covid-19 pandemic served as a catalyst for the implementation of home-based care.

For example, the hospital I worked at established a 24-hour Telemedicine Command Centre, staffed with doctors and nurses, who provided remote consultations to thousands of patients.

This realisation that healthcare could effectively extend into patients’ homes marked a fundamental moment in the transition towards home-based care.

However, telephone consultations fall short of comprehensive care.

So, as we moved past the lockdown era, innovative hospitals in the US and Singapore started discharging patients early, but provided follow-up care through video calls, home visits, remote monitoring devices and educational materials.

Countries like Australia have made considerable strides in the hospital-at-home model, particularly for sub-acute patients.

In the state of Victoria alone, these services offer an equivalent level of care to what a 500-bed facility can provide in one year.

Patients are now receiving treatments such as intravenous (IV) fluids, oxygen, medications, insulin and various forms of therapy in the comfort of their homes.

What this has taught us is that healthcare systems are comprised of many interconnected points of care and that hospitals do not function in isolation.

Safe and effective

There is compelling evidence that well-monitored, at-home care can be safe and effective for eligible patients.

Research by the Medical Journal of Australia in 2020 has shown that patients treated at home demonstrate outcomes that are just as effective, if not superior, to those treated in a hospital setting.

Elderly patients, in particular, benefit from being in familiar surroundings, with significantly lower chances of contracting hospital-acquired infections and experiencing anxiety and confusion.

A recent study, published in the American Journal of Accountable Care, further underscores the value of home health as a favourable alternative to hospitalisation for patients who do not require a hospital stay.

The study demonstrates that patients treated at home experience fewer readmissions to the hospital, resulting in reduced utilisation and associated expenses.

Additionally, there are several other advantages, including:

> Shorter recovery time

This can be attributed to factors such as unrestricted access to loved ones, familiarity of environment and decreased risk of hospital-acquired infections.

> Cost-effectiveness

Home care is generally less expensive than full-time room and board at a nursing facility, an assisted living centre or a hospital.

Research conducted by investigators at Brigham and Women’s Hospital in Boston, US, revealed that the cost of home care for the patient was nearly 40% lower.

Their study assessed the total direct cost of care, encompassing expenses related to non-physician labour, supplies, tests, and medications.

> Increased flexibility and independence

Patients receiving care in a home-based environment enjoy greater flexibility in their meal schedules and have more freedom of movement, along with the ability to receive visitors at their convenience.

Key challenges

While the benefits of early discharge and home-based care are clear, there are challenges that need to be addressed to make this approach successful on a broader scale.

One of the key challenges is technological barriers.

Remote monitoring apps and devices are essential elements in the hospital-at-home model.

It is necessary to ensure that patients, especially the elderly, can effectively use such devices, and a learning curve has to be factored in while providing care.

We also certainly cannot overlook the human element.

Many patients that I know of still place a high value on face-to-face interactions and prefer the reassurance of having a healthcare professional physically present.

The challenge is to strike a balance between technological solutions and traditional care approaches.

There are also concerns about the quality of care delivered at home as a hospital environment is generally a sterile and controlled environment, which is not the case with patient’s homes.

Oftentimes, medical personnel who visit homes have to educate the patient and their families in managing medication, equipment and rehabilitation, as well as advise on adjustments needed in their habits and environment to optimise recovery.

Additionally, in the Malaysian landscape, many providers of home-based healthcare are not part of the discharging hospital’s spectrum of care.

This could pose problems in ensuring continuity between the patient’s treatment plan as required by their primary doctor, as opposed to what is delivered by the home-based provider.

Communication might be lacking between these two healthcare teams, which could affect the patient’s care.

An alternative solution

As overcrowded hospitals continue to be a pressing issue, the early discharge and home-based care model provides a solution that benefits patients, healthcare institutions and the healthcare system as a whole.

The perception that hospital overcrowding is caused by an inadequate number of inpatient beds often lead to demand for more beds by the community.

However, the reality is that adding beds also adds to the ongoing expenditure and healthcare burden of the nation, as the rates of readmission and recovery for purely hospital-based patients may not be as beneficial, compared to home healthcare.

Many studies have shown that patients in home care programmes tend to comply with treatment plans and incorporate changes in their homes.

We need to encourage a mindset change that would enable us to shift aspects of hospital care to the community and homes, thereby reducing the need for patients to stay longer than necessary in hospitals.

One easy way to help achieve this would be to include home healthcare in the spectrum of services provided by hospitals.

This would help inspire confidence in the level and continuity of care provided, as well as encourage insurance providers to view such services as part of a patient’s treatment plan.

I believe with the right strategies, continued innovation, and collaboration between public and private healthcare sectors, Malaysia can lead the way in this transformative approach to healthcare delivery.

It’s high time we bring the hospital to the home.

Dr Khoo Chow Huat is the managing director (Healthcare and Hospital Operations) for Sunway Healthcare Group. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Wellness,Healthcare,home care,hospital
One way of managing overcrowded hospitals is to discharge suitable patients early and continue their care at home.