Shift happens: Are hospitals morphing into something new?

Technological advances, along with a push for higher-value care are transforming the healthcare industry before our eyes. Even the hospital’s traditional role as the centre of gravity for patient care is shifting.

But does this mean that hospitals will soon be a thing of the past? The authors of a recent blog post in the US New England Journal of Medicine (NEJM) say perhaps not, at least for the foreseeable future – but that their role as a centralised ‘hub’ of care is already beginning to change.

So what’s driving this trend towards more decentralised care? The spread of electronic health record systems (EHRs), along with initiatives geared towards standardising patient data lay the groundwork for more geographically dispersed care coordination, say the report’s authors. Meanwhile, other tech advances and industry trends are further catalysing the decentralisation of care, pushing it from hospitals to primary care setting, outpatient clinics and patients’ homes.

We can see this trend manifested in a marked rise in smaller hospitals with a narrower focus on critical and acute care; telehealth technology that allows for virtual consultations and remote patient monitoring and in the increased portability of diagnostic devices and increased availability of wearables, says the report, among other things. A focus on value-driven quality care, too, has put a premium on preventative care and improving overall population health, while penalising hospitals for readmissions, says the US report.

Changes like these, along with the increasing mobility of community-health providers, such as community paramedics - who deliver care to high-risk patients at home - have shifted the mix of hospital admissions to the point where 80 per cent of them now come from the hospital’s own emergency departments, say the report’s authors. This is causing disruption in its own right, as hospitals reinvent their emergency departments to cope more effectively with their role as the hospital’s expanded front door.

Along with the increasing pressure to create a healthcare system that is value-oriented, patient-centred and also lower cost, there is a need for safe alternatives to expensive hospital-based care, says the report: “Just as decentralisation has critically transformed other industries, like computing, for instance – the reorganisation of healthcare is beginning to take shape. And as we enter this next step in the evolution of healthcare, it is worth remembering that hospitals were once a last resort for those who could not afford to receive care at home.”

Are there the signs of us beginning to turn full-circle in this respect, perhaps?

You can read the NEJM Catalyst blog post here.

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