ACH DHM Overview
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UNC Health's Advanced Care at Home
May 2025
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UNC Health's Advanced Care at Home provides a safe alternative hospitalization experience for many Internal Medicine patients with: Lower mortality Lower SNF discharges
AHCAH CMS Waiver still mandates that hospital-at-home patients must originate from a physical hospital (emergency department or inpatient floor).
Advanced Care at Home can screen eligible patients via Epic Chat to "UNCH/Rex - Advanced Care at Home Hospitalists" or calling Mission Control at 984-974-7900
Take Home Points
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Outline
UNC Health’s Advanced Care at Home (ACH)
Referring to ACH
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UNC Health's Advanced Care at Home
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Advanced Care at Home: Overview
10,784 days
2,505 patients
658 patients
8/30/21-12/31/24
Number of patients treated
Number of Acute Substitutions
Total hospital days spent in the home
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Advanced Care at Home: Eligibility Criteria
Eligibility for acceptance into Advanced Care at Home
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Advanced Care at Home: Mission Control
Virtual Hospitalist Screens and admits patients Directs plan of care Daily virtual visits
Advanced Practice Providers (APPs) Screens and admits patients Daily virtual visits In-home visits as needed
Virtual Nurses Provides 24/7 triage, care access and medical advice Conducts assessments during virtual rounds at least 4x/day
Network Service Coordinators Directs fulfillment of home-based services Supports documentation to patient record, including required information for billing
Patient Admissions Officer (PAO) Oversees screening and enrollment of patients across all hospital sites
Patients are assessed at a minimum 7x/day. First visit with a provider is within an hour of arrival to the home.
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Advanced Care at Home: In-Home Technology
CesiaTM : Patient Facing Tablet
Biometric Tools & Connectivity Support
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Advanced Care at Home: Rapid Response Network
Lab Testing Point-of-Care and Hospital Laboratory
Community Paramedics and NPs Managing both routine and rapid response visit types
Home Health Resources Including Nursing, Therapists and Home Health Aides
Pharmacy Infusion and oral medications such as IVF, steroids, antibiotics, diuretics and more
DME / O2 Delivery
Mobile Diagnostics ex. X-Ray, EKG, Ultrasound, Echo
Medical Meals Personalized to preference and dietary restrictions
Medical Supplies Including standard kit and additional customized supplies as needed
Consults Video visits or e-consults with brick and mortar clinicians
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Advanced Care at Home: Patient Escalation Pathways
Dispatch our paramedics for an urgent visit accompanied by MD on video visit
Can perform POC testing - VBG, lactate, chem8, hemoglobin, ECG
Paramedic formulary examples Antibiotics – vancomycin, piperacillin/tazobactam, cefepime, ceftriaxone, levofloxacin, metronidazole IV fluids IV diuretics (bumetanide and furosemide) IV steroids Others – albuterol, nitroglycerin, norepinephrine, atropine, epinephrine
Often can stabilize patient and keep that at home but can transfer patient back to brick & mortar if needed Depending on urgency / bed availability either directly to hospital room or thru emergency department
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Data collection currently in progress
Data Range: July 1, 2023 – June 30, 2024
Advanced Care at Home: Clinical Outcomes for FY24
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Advanced Care at Home: Patient Referrals
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Call 984-974-7900 to speak with the on-call team
Epic Chat
Phone call
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We can screen patients in clinic for expedited admission Referrals are processed 7 days a week, 7a-8p.
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ACH can screen patients between 7:30a-7:30p and can transfer patients between 9a-12a. Patients often want to hear about ACH from their in-person physician; your initial discussion is helpful. ACH works in close coordination with the MAO for bed coordination
Please note: currently CMS requires patients to be inpatient status
Advanced Care at Home: Patient Referrals
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Balancing Risk in Hospital at Home
5/13/2025
For appropriately selected patients, home hospital care has a superior safety and efficacy profile relative to usual hospital care.
Risks of Hospital-at-Home Lower control environment Home may not be therapeutic No BIPAP, mechanical ventilation No surgical procedures No urgent CT, MRI, LHC, LP No in-person physician visits
Risks of Traditional Hospital Higher control environment Falls, delirium, loss of function Exposure to infectious vectors High risk of d/c to rehab Higher readmissions in RCTs Higher mortality in RCTs
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UNC Health's Advanced Care at Home provides a safe alternative hospitalization experience for many Internal Medicine patients with: Lower mortality Lower SNF discharges
AHCAH CMS Waiver still mandates that hospital-at-home patients must originate from a physical hospital (emergency department or inpatient floor).
Advanced Care at Home can screen eligible patients via Epic Chat to "UNCH/Rex - Advanced Care at Home Hospitalists" or calling Mission Control at 984-974-7900
Take Home Points
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Questions? Michael Craig, MD MPH SFHM Medical Director, Advanced Care at Home [email protected] Patrick O'Shea, MD MBA Associate Medical Director, Advanced Care at Home [email protected]
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