Ed Dickinson, MD, FACEP, FAEMS
Sandy Jost, RN, MSN, PhD
Maria Buccafuri, PT
Katherine Major, RN, MSN, CHPN
Danielle Flynn, MSN
Joan Doyle, RN, MSN, MBA
Vivek Ahya, MD
Michael Sims, MD, MSCE
Innovation Accelerator Program
IBX Clinical Care Innovation Grant
Patients with chronic diseases are complex, and many have one or more comorbidities that put them at higher risk for readmission.
Traditional hovering and telemedicine platforms can catch issues early – some of which can be resolved via home-based intervention. However, patients experiencing more severe issues are usually instructed to call 911 or present to the emergency department (ED) – which often results in a hospital stay.
Cavalry is a novel program that provides hospital-level medical interventions at home at a fraction of the cost of readmission.
The program was initially designed to serve patients enrolled in Breathe Better Together (BBT), a hospital-to-home program for patients with chronic obstructive pulmonary disease (COPD), a chronic inflammatory lung disease that causes airflow blockage and breathing-related problems.
When a BBT patient's needs could not be met over the phone, Cavalry sent an experienced Penn Care at Home nurse to make a same-day acute care visit. After evaluating the patient, the nurse contacted the on-call pulmonologist and coordinated interventions such as administering IV corticosteroids, antibiotics, and/or diuretics.
If a patient was deemed too ill to treat at home, the nurse contacted emergency medical services so that the patient could be transported to the hospital.
In the initial pilot phase with more than 150 high-risk COPD patients at the Hospital of the University of Pennsylvania (HUP), Cavalry prevented 82 percent of readmissions. And patients reported high satisfaction as the program saved them hours they would have spent in the ED.
The Cavalry team is currently working to scale the program across the health system and plans to test the intervention in other high-risk populations, such as patients with cancer, asthma, and heart failure.
Maintaining pilot results at scale would result in substantial cost savings for both payers and the health system.
High-fidelity learning can come from low-fidelity deployment.
Mini-pilots will allow you to learn by doing, usually by deploying a fake back end. You might try a new intervention with ten patients over two days in one clinic, using manual processes for what might ultimately be automated.
Running a "pop-up" novel clinic or offering a different path to a handful of patients will enable you to learn what works and what doesn't more quickly. And, limiting the scope can help you gain buy-in from stakeholders to get your solution out into the world with users and test safely.
To determine the efficacy of the same-day acute care visit model, the team launched a 20-day pilot leveraging existing ride-sharing services and borrowed medical supply backpacks from the helicopter-based trauma team.
Rapidly deploying the service enabled the team to validate that seemingly inevitable admissions could be prevented at a very low cost. While this started as an approach to learning what happens when patients are at home, it became the foundation of the Cavalry intervention.