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Michigan Medicine

A Minute with Marschall

How culture shapes success: Care at Home

February 21st, 2022

Our U-M Health initiative of the year, Care at Home, makes so much sense. When we offer safe, hospital-level care to patients in their own home, we improve the patient experience, increase access to our exceptional care, free up beds for others in need and build a sense of belonging within our communities.

Although this is a relatively new care delivery model for health systems like ours, early data indicates that programs across the country like Care at Home show positive results. For example, research studying Johns Hopkins’ Hospital at Home program (among the first such models in the country) found that providing acute-level care at home for a discrete set of conditions was not only 32 percent less costly, but safer as well, with a dramatically lower incidence of delirium, among other complications.

Randomized controlled trials of other programs found similar conclusions. They showed that patients treated at home had lower mortality rates and fewer costs, while experiencing higher levels of satisfaction due to the closeness of their support networks and less disruption in their lives.

In our first year of offering this unique, and very compassionate, health care option to our patients, our goal is to reach an average daily census (ADC) of 10 patients in the Care at Home program by June 30, 2022.

We have seen progress. We are consistently serving over five patients per day, and while it seems like a small number, it was no easy task reaching that incremental milestone. Indeed, it has been a great accomplishment. When the pandemic created an urgent need for hospital beds and amplified our concerns about access to our care, the newly created Care at Home team went to work at a rapid pace. They gathered expert staff members, put remote monitoring technology in place and used a blend of virtual and in-person visits, to provide safe, high quality in-home care for our vulnerable COVID-19  patients.

Now that our infrastructure is in place, we are poised to expand the program and offer this care delivery option to many more diverse patients. Together, we can do this, but it means we must take a step out of our cultural comfort zone. We will only grow this program if we change our mindset and behaviors about the traditional patient discharge process. We need to increase the volume of internal referrals, which means keeping the Care at Home criteria top of mind when considering if a patient can complete care at home or avoid being admitted altogether.

The Care at Home program can now be considered for many different patient populations. If you think a particular area can benefit from these home-based services and improve patient satisfaction and outcomes, please provide more information to the Care at Home team through this CAH Survey.  You can also learn more about our initiative of the year on the Path Forward website.

The Care at Home program challenges us to think creatively and reach beyond our past experiences and understanding of what hospital care looks and feels like. If we can embrace innovation and change, our initiative of the year will be a great success. 


  • After nearly two years of living through a pandemic, where we’re all encouraged to stay home and stay safe and our health is at the forefront of our minds. It only makes sense that safe, accessible, care at-home forms of self-care have become a priority.
    I’m very excited to hear about the success of this innovative care model launched at Michigan Medicine. This wonderful program allows our patients to receive the same standard of high quality care that they would normally receive within our hospital walls in the comfort of their homes.
    I have no doubt that this program will successfully expand to serve even more diverse patients who desperately need the care and healing. I truly appreciate everyone’s hard work and the great efforts put in to support our patients and communities, continue to provide the best care possible and enhance the patient experience.

    • Marschall Runge

      Well said, Lamia. I appreciate your feedback, and I am sure the Care at Home team will as well. I share your optimism that Care at Home will continue down a successful path and I agree that the team has done an exceptional job building this program so we can provide more care options for our patients. Thank you for your comments.

  • Please consider the safety of the staff when setting visit guidelines. As well as the condition of the patient and ability to absorb education initially being discharged from the hospital. Transitions of Care programs have definitely shown that patients understand and will follow instructions after they feel safe at home within the first week. Understanding the goal of Care at Home is an extension of the hospital at home- safely.

    • Therese, I strongly agree with you that safety should be among our top priorities, for both our patients and our staff, when developing and implementing programs within our communities. The Care at Home team has developed guidelines around this and DPSS, our security team, has a training program in place which has been used for those who visit our patients in their homes. Thank you for sharing your concerns.

  • This is really exciting to read. I lived in Finland and have aging family there now. The health care system in Finland offers at-home care for their aging population and I truly didn’t think I’d see a push for it here in the US. It makes sense but I’m sure major growing pains at the beginning.

    • It’s nice to hear that you have seen good results from care at home programs in Finland. There are certainly a lot of programs around the world which we can learn from. Our biggest growing pain now is to adopt a culture among our faculty, staff and learners so they are comfortable with this new health care model and recognize it as a way to provide additional access to our exceptional hospital-level care to our patients. Thanks, Wendy, for sharing this information.

  • I really like this idea mainly because as a patient I am more comfortable at home rather than a hospital. Kudos to the team for making this possible.

    • When we ask our new Care at Home patients what they most like about their experience, they often talk about how much they appreciate receiving care in the comfort of their own home, among family, friends, even their pets. For us, it’s a new way of thinking about how we care for our patients. Thank you for your thoughts, and I agree, kudos needs to go to the small but mighty team that is now building this new program for us.

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