Opportunity

Emergency clinicians make difficult decisions about whether patients require hospitalization or can be discharged home. Patients are often admitted or observed in the hospital because safe outpatient care plans cannot be coordinated or because patients lack the support necessary to recover safely at home.

Unfortunately, these potentially avoidable admissions strain hospital capacity. In 2018, 25 percent of patients admitted from the emergency department (ED) at Penn Presbyterian Medical Center (PPMC) were discharged within 48 hours – signaling an opportunity to care for patients entirely outside the hospital walls. We have also found that patients would often prefer to recover from acute illness at home if deemed safe and practical to do so by their provider.

Intervention

PATH provides a practical alternative to hospitalization for ED patients by expanding the point-of-care options available to providers and deploying health system resources in the home setting.

First, the program leverages a customized dashboard to identify ED patients under consideration for hospital admissions or observation stays who qualify for home treatment. Then, once identified, the PATH team collaborates with ED physicians, primary care providers, families, and the patient to develop a personalized outpatient plan. 

After discharge, all patients receive a next-day phone call from the Penn Medicine at Home PATH team to discuss symptoms, adjust treatment plans, and address patient or family concerns. Additional PATH services include coordination support to arrange outpatient appointments and testing, home health services for eligible patients, home infusion and laboratory services, and identification of health-related social needs.

Impact

Through a series of rapid pilots at PPMC, we demonstrated that PATH could provide patients with the right care in the right place at the right time. Both patients and clinicians expressed satisfaction with the program during early pilots and the vast majority of patients were able to recover safely at home without needing to return to the hospital.

With support from Independence Blue Cross, we completed a randomized clinical trial with PATH at PPMC in 2021. Patients who were offered PATH spent 3.4 fewer days, on average, in the hospital than patients who received usual care, and their return hospitalization rate was 14 percentage points lower.

PATH was relaunched at PPMC in September 2024. The team is using a phased approach to implementation that expands the set of eligible diagnoses in stages and continually refines the program.