College of Health’s Michael Gusmano Partners with BAYADA Home Health Care

Can very sick children with complex medical conditions have better health outcomes by receiving more intensive home health services instead of receiving care in the hospital?

That’s what Professor Michael Gusmano is exploring this academic year through a partnership with BAYADA Home Health Care, a leading provider of clinical care support services at home for children and adults. 

In particular, he is focusing on BAYADA’s HICU Health Services (Home Intensive Care Unit), a program of home health services for medically fragile children to allow them to live and thrive at home once they are medically ready for discharge. Without this program, these children would otherwise have to be cared for in the hospital. 

“Typically, these include children who have complications related to premature birth, children with conditions that require ongoing respiratory support and monitoring, and/or children who have feeding and digestive issues requiring feeding tubes or other feeding assistance,” Gusmano explained. “Many of the children in the HICU program rely on medical technology, including feeding tubes and ventilators.”

The HICU program aims to keep these children out of the hospital by providing more intensive home health services, resulting in a better quality of life for the patients and their families, as well as lowering costs.

“The reason they believe it may save money, and improve health outcomes,” Gusmano said, “is that the program gets kids out of the hospital sooner and helps them to avoid rehospitalization by providing the intensive care they require in the home — and that care is provided by professionals and by the family with support from these professionals.”

Over the course of a year, Gusmano is working closely with BAYADA staff to fully understand the benefits and challenges of this program. Specifically, Gusmano, along with E.J. Rovella, a doctoral student at the College of Health, is conducting a mixed methods study, comparing medically fragile children who have been enrolled in the HICU program with a matching cohort of other BAYADA treated medically fragile children who are not in the HICU program. 
They are examining administrative data, looking at rates of hospitalization and emergency department use, to see if children in the HICU program are avoiding unnecessary hospitalizations and emergency department use.

Further, they are conducting multiple rounds of in-depth interviews, speaking with families of children in the program to learn about the experience of caring for a child who is medically fragile. “What do they like about the care their child is receiving? What’s challenging about it? How has this helped? How has this been burdensome?” he added.

In addition to speaking with families with children who are not participating in the program, the team is interviewing BAYADA’s administrators and clinical staff, including executive leadership, middle managers, clinical managers, nurses, and other staff members working in the home to understand their perspectives. 

According to Gusmano, some payers are using value-based contracts with BAYADA for their patients in the HICU program, and he will be speaking with administrators and clinicians to help determine if using value-based contracts changes anything about the way that care is delivered.

“We are excited and proud of our new innovative care model that will enable us to help more and more children safely transition home — where they should live,” said Karen Smith, MBA - Division Director, Operating Model and Innovation - Skilled Nursing, BAYADA Home Health Care. “Our partnership with Lehigh is allowing us to bring to life the value of our HICU Health Services program and provide insights for future evolution and care design.”