Quebec pilot project will bring hospital care to patients at homes

Quebec will begin rolling out home hospitalization care in several parts of the province in the next few months as part of a pilot project, the government announced on Monday.

The move will allow patients to be able to recover in the comfort of their own homes, while being seen virtually by a medical team, according to the office of Sonia Bélanger, the minister responsible for seniors. 

"This approach allows users to keep their independence while avoiding the possible negative consequences of hospitalization," Bélanger said, adding that seniors are particularly at risk with long-term hospital stays.

Patients will also be able to contact a nurse by phone around the clock every day of the week and will have the same access to consultation and exam services offered at the hospital. Patients' participation in the pilot project will be on a voluntary basis. 

Eight health territories should be able to offer this service to patients by 2024, said Bélanger.

This first phase of the project will see three territories in Montreal implement home care with others in Quebec City, Laval, Monteregie, Lanaudiere and the Laurentians.

However, the ultimate goal is to implement home hospital care in all 34 of the province's health establishments and centres.

Quebec could expect to free up about five per cent of hospital bed capacity,  Bélanger said, pointing to the experience of Montreal's Jewish General Hospital, which carried out its own virtual care pilot project in recent years. 

Dr. Vincent Oliva, the president of the Quebec Federation of Medical Specialists (FMSQ), said the changes would not only save Quebec money but also result in shorter treatment time for patients and more favourable health outcomes. 

"When we go to the hospital, we are not at home. We are less comfortable. We can catch secondary infections," said Oliva.

Quebec should take advantage of its advanced technologies in areas such as artificial intelligence to monitor blood pressure and blood sugar at a distance, he said. 

"It's important to understand that it's not just for patients who have undergone surgery. It is also for patients who have somewhat unstable medical conditions, for example, heart failure, kidney failure, diabetes or [patients] who need adjustments to their medication."  

Health establishments will be able to develop their own unique approaches, he said, with the virtual-care patients receive depending on their needs as well as the type of care the establishment provides. 

The Institut de la pertinence des actes médicaux — an independent institute that seeks to find savings and reinvest them into Quebec's medical system — will provide some funding for the project with $40 million by 2026.

A long time coming, but questions remain

Dr. Michaël Bensoussan, head of the Charles Lemoyne Hospital's gastroenterology unit, has long called for more virtual care to help reduce crowding in the province's hospitals. 

In his own practice, Bensoussan's patients, often suffering from kidney failure or liver failure, remain in the hospital for weeks or months after receiving emergency treatment, even though they can effectively receive subsequent care outside the hospital. 

But he has some concerns about how Quebec may go about delivering the changes.

Whether a patient needs a bandage change or physiotherapy, the province will need to find nurses and other health-care workers to tend to the patients, he said.

"Where is the minister going to find the resources for it?" 

Bensoussan  also worries about how patients will experience this shift. Treatments can be administered anywhere but care requires a human touch, something he said might be lost if the project is not properly executed.

Paul Brunet, president of the Quebec Council for Patients' Rights, also wants to see patients receive care at home — as long as doctors, not only nurses and other health-care providers, follow up with those patients with an in-person housecall.