Paving the Way for More Patients to Benefit from Advanced Care at Home
Ann Arneson describes her journey to Mayo Clinic as “divine design.”
Ann — a retired teacher, a leader in her church and ministry, mother, grandmother, and line dance enthusiast — is Mayo Clinic’s first bone marrow transplant patient to recover at home thanks to the new advanced care at home program.
“I know that people and circumstances are not by chance, but for a purpose — part of a bigger plan,” says Ann.
A brush with death and devastating news
Ann was living in California with her husband, Don, in March 2019 when she received a devastating diagnosis: She had multiple myeloma, a cancer that forms in a type of white blood cell called a plasma cell.
“We were going in for a routine doctor’s appointment and getting our labs,” says Ann. “They called me that night and told me to get to the hospital first thing in the morning.”
Ann was quickly admitted to the hospital where she received her life-changing diagnosis of cancer. But her battle was just beginning. Two months into her chemotherapy treatments, she contracted pneumonia and cellulitis, a potentially serious bacterial skin infection.
“I ended up going into respiratory arrest,” says Ann. “My friend called 911. In the ambulance I understand I quit breathing and they had to revive me.”
Ann and her husband knew they needed more support — and they knew where to go. The couple, who had discussed moving to Florida in the future for long-term health care needs, say they hadn’t imagined the need would be so immediate. They packed their belongings and relocated their life to Jacksonville.
“I knew I needed to be here at Mayo Clinic,” says Ann.
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The Mayo Clinic Platform
Mayo Clinic is leading the transformation of health care. Through the Mayo Clinic Platform, experts are enabling new knowledge, solutions and technologies that will create a healthier world where personalized, predictive and innovative care is accessible to all.
The Mayo Clinic Platform’s virtual care initiatives create remote offerings throughout the care continuum, and advanced care at home is the first program. Launched in July 2020, advanced care at home is reimagining health care by making the core capabilities of an inpatient hospital unit available within a home setting. This enables acutely ill patients who qualify and opt into the program to receive complex care in the comfort and safety of their own home.
Already, more than 800 patients have used the program, and 96% say they would recommend the program to others. Additionally, the percentage of advanced care at home patients who are readmitted to the hospital within 30 days is 5%, compared to around 16% to 18% in an equivalent cohort of patients in the brick-and-mortar hospital setting.
In May 2021, Mayo Clinic and Kaiser Permanente announced an investment of $100 million in Medically Home, a Boston-based, technology-enabled services company and Mayo Clinic's partner for implementing advanced care at home. The collaboration between Mayo Clinic, Kaiser Permanente and Medically Home created an opportunity to scale the advanced care at home model to more patients with serious or complex needs, including a pilot in Florida for patients who are in need of an autologous transplant for multiple myeloma.
Stem cell transplant offers hope
Ann continued chemotherapy to treat her multiple myeloma as well as radiation to treat a lesion at the base of her skull.
A year later, in March 2021, a scan showed the cancer had jumped from her bone and bone marrow to soft tissue. She had a tumor in her small intestine. Ann underwent abdominal surgery to remove the cancer.
After a successful surgery, Ann met with Vivek Roy, M.D., a hematologist-oncologist at Mayo Clinic, who specializes in advancing care and treatment options for patients with multiple myeloma and other blood cancers.
“My prognosis was unsatisfactory, and that’s when I found out about the option for bone marrow transplant,” says Ann.
Ann learned that she was a candidate for autologous stem cell transplant, a procedure that replaces damaged blood-making cells with the patient’s own healthy cells.
Option to recover at home - "Somebody was always there"
In addition to a successful transplant in June 2021, Dr. Roy gave Ann more good news. She had the opportunity to recover at home as part of Mayo Clinic’s advanced care at home program, a model that takes the care provided in the hospital setting and brings it to the patient in the comfort and safety of their own home.
“Dr. Roy felt I was a good candidate, and I said, ‘Absolutely!’ I’m just comfortable at home,” says Ann.
Launched in 2020, the advanced care at home program has helped more than 800 patients. Mayo Clinic is working to expand the program both in terms of geographical footprint as well as the types of conditions that can be considered for the program. Mayo Clinic in Florida is piloting advanced care at home with patients who have received an autologous transplant for multiple myeloma. Ann was the first patient to participate.
“Ann met advanced care at home criteria as she lived within the radius of our command center in Jacksonville, had inpatient hospital care and monitoring needs we could implement safely in her home with close coordination with our BMT colleagues, and had strong social support with her caring husband,” says Gautam Matcha, M.D., Mayo Clinic’s medical director of the advanced care at home command center in Florida. “I think this allowed her to thrive in the ‘hospital at home.’ The advanced care at home team was enthusiastically supporting her through this phase of her journey.”
The program allowed Ann to reduce her inpatient hospital stay by 14 days — time she was able to spend with her husband and recover in the comfort of her own home.
Through the advanced care at home program, part of the Mayo Clinic Platform — a portfolio of initiatives that harness the power of data and technology to transform health care — Ann received 24/7 access to Mayo Clinic providers through an audiovisual module. Under the direction of her physician team, she received skilled nursing care, remote monitoring and other essential services from a network of EMTs, nurses and medical technicians.
Advanced care at home equips patients with a tech pack that includes secure, HIPAA-compliant Wi-Fi; blood pressure monitors; any needed medical supplies; a tablet that provides 24/7 virtual connection to Mayo Clinic experts; and a “life alert” device that looks like a watch and can initiate an emergency two-way voice communication with the command center. Patients also receive a schedule, so they know what to expect and when. Everything is set up, connected and tested, and the patient receives a physical exam to ensure the transfer was safe and successful.
“It was very easy,” says Ann. “I had the help button by my bed. I wore the watch so all I had to do was hit that and it would dial the care team directly. We used the iPad at least every four hours, sometimes more often. I had a care team member right there, and I could show them what was going on. Somebody was always there.”
Ann says she felt confident receiving care at home even though she knew her condition made her immune system more vulnerable. Her in-person care providers used safety precautions, including personal protective equipment such as masks and gloves to keep her environment safe, and she’s been careful to stay indoors due to COVID-19.
“The staff all along the way were so caring and compassionate. From the paramedics, nurse practitioners and physician assistants to the person who came into my apartment to pick up the blood or deliver medication, they would ask, ‘How are you doing? Do you have everything you need? Is there anything else we can do for you?’”
Grateful to have more time
Ann continues to stay connected to her care team as she progresses in her journey. At 100 days post-transplant she will have another bone marrow biopsy and will be able to receive vaccines that will help her return to doing the things she loves.
“I can’t wait to get back out and be involved in the community, go for walks, and get back to line dancing and teaching Bible study,” says Ann. “I want to see my grandkids grow up. I have more to do in this life.”
Ann says she hopes her journey will help pave the way for more people to benefit from advanced care at home.
“I want to encourage people and give them hope,” says Ann. “I’m just so excited about life. I knew this was what I needed to do, and I never looked back. I am so grateful to have more time.”
Eds Note: The individuals featured in images were following social distancing guidelines, and in compliance with Mayo Clinic’s COVID-19 safety guidelines while unmasked.