Mass General Brigham Receives $4.6M Grant to Study Short-Term Rehab at Home

Grant from the state’s Executive Office of Health and Human Services will fund a randomized controlled trial for rehab care that could improve patient outcomes, reduce cost and address city-wide hospital capacity challenges

The Massachusetts Executive Office of Health and Human Services (EOHHS) has awarded $4.6 million to Mass General Brigham to evaluate the delivery of short-term rehab care at home. Through a randomized controlled trial, Mass General Brigham will test the effect of delivering short-term rehab care at home versus at a traditional post-acute care setting, commonly termed a skilled nursing facility (SNF).

Nationally, about 40% of older adults discharged from acute care hospitals require some sort of post-hospital care, and about half of those receive care in an inpatient skilled nursing facility. The cost of skilled nursing facilities is increasing, and the COVID-19 pandemic exacerbated the staff shortages and capacity challenges these post-acute care facilities face.

Delays in discharging patients from acute care hospitals to post-acute care settings have posed a challenge that has contributed to capacity issues nationwide, preventing patients from accessing the rehab care they need and preventing open beds for new patients in need of acute hospital care. According to the latest report by the Massachusetts Health & Hospital Association, 1,972 patients are awaiting to be discharged from hospitals across the state, showing that patients can wait for weeks or months before finding a bed and accessing the care they need.

“If successful, this care model may lead to a complete transformation of how we deliver advanced rehab care to our patients,” said David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, and principal investigator of the trial. “There are not enough rehab beds in Massachusetts, and if we can substitute facility-based care with home-based care, we will be able to help alleviate the capacity crisis that our healthcare systems have been experiencing across the state. This would have an immediate benefit for patients, family caregivers and clinicians.”

As part of the study, 300 patients will be enrolled from five acute care hospitals in the Boston area: Massachusetts General Hospital, Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital, Boston Medical Center and Cambridge Health Alliance. Of those 300, 150 patients will be randomized to receive short-term rehab care at home, while 150 will receive care in the traditional skilled nursing facility. Patients admitted to rehab care at home will see a nurse, certified nurse assistant, physician, and home health aide upon admission. Subsequent care will include daily remote physician and in-home certified nurse assistant visits. Physical, occupational, and speech therapies are also available and tailored to patients’ needs. Patients will also benefit from 24-hour, in-home response from mobile integrated health paramedics and, as needed, home health aide care.

A unique aspect of the trial will be that researchers will also evaluate the experiences of family caregivers and clinical staff, examining burden and burnout among those groups.

In 2019, Levine and colleagues ran a pilot randomized controlled trial of 10 patients to test the ability to deliver SNF-level care at home. Results were promising and pointed toward lower cost and a better patient experience compared to traditional SNF care. However, the small patient cohort required replication with a much larger patient cohort.

“Now, thanks to this financial award by EOHHS, we can test this innovative care delivery model that reimagines how we deliver post-acute care,” Levine said. “At Mass General Brigham, we are leaders in the advanced home-based care space. One of our goals is to create the evidence base that will be a pathway for the country’s healthcare systems to follow nationwide.”