SYSTEMS AND METHODS FOR HEALTHCARE DELIVERY, OBSERVATION, AND COMMUNICATION BETWEEN A DE-CENTRALIZED HEALTHCARE SYSTEM AND A PATIENT LIVING AT HOME

• US 20110105853A1
• Filed: 09/10/2010
• Published: 05/05/2011
• Est. Priority Date: 09/11/2009
• Status: Abandoned Application

• Current Assignee: TLC Holdings I, LLC (Amedisys Incorporated)
• Original Assignee: Clincally Home, LLC
• Inventors: Saita, Judy, Chess, David, London, Alan, Walton, Matt, Rakowski, Richard R.
• Application Number:
  US12/879,192
• Publication Number:
  US 20110105853A1
• Time in Patent Office: Days
• US Class Current: 600/300
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 99/00 Subject matter not provided for in other groups of this subclass

Abstract

The disclosure describes de-centralized healthcare systems and methods of using the same to provide healthcare to a subject living at home. A de-centralized healthcare system of the invention provides at or above hospital-level care through the implementation of care pathway protocols for effective treatment of designated health conditions. A subject is monitored by a central station, which is staffed by healthcare practitioners and providers. A dispatch system allows healthcare providers to visit the subject for appointments and deliveries. The de-centralized healthcare system provides for the subject'"'"'s laboratory, nutrition, and hygiene needs.

Claims

1. A de-centralized healthcare system comprising:

a) a central station staffed by at least one healthcare practitioner;

b) a plurality of care pathway protocols, wherein each care pathway protocol comprises a protocol for providing healthcare for a selected designated health condition to a subject in need or want thereof; and

c) a communication system for communication between the subject and the healthcare practitioner,

wherein the subject resides at a location remote from the central station and is registered with the de-centralized healthcare system.

2. The de-centralized healthcare system of claim 1, wherein the central station is effective to monitor the health, status, and location of the subject.

3. The de-centralized healthcare system of claim 1, wherein the central station further comprises a record-keeping system, a computing system, and a library of reference materials, wherein the record-keeping system comprises a record for each subject registered with the de-centralized healthcare system.

4. The de-centralized healthcare system of claim 1, wherein the designated health condition comprises one or more of:

heart transplant or implant of heart assist system;

craniotomy and endovascular intracranial procedures;

extracranial procedures;

multiple sclerosis and cerebellar ataxia;

intracranial hemorrhage or cerebral infarction;

transient ischemia;

nonspecific cerebrovascular disorders;

seizures;

headaches;

disequilibrium (vertigo);

major chest procedures;

other respiratory system operating room procedures;

pulmonary embolism;

respiratory infections and inflammations;

respiratory neoplasms;

pulmonary edema and respiratory failure;

chronic obstructive pulmonary disease;

simple pneumonia and pleurisy;

bronchitis and asthma;

respiratory signs and symptoms;

respiratory system diagnosis with ventilator support;

deep venous thrombosis, chronic heart failure;

cardiac valve and other major cardiothoracic procedures;

cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction/heart failure/shock;

cardiac defibrillator implant without cardiac catheterization with major coronary bypass with percutaneous transluminal coronary angioplasty;

major cardiovascular procedures or thoracic aorta;

permanent cardiac pacemaker implant;

percutaneous cardiovascular procedure with drug-eluting stent or other circulatory system operating room procedures;

other vascular procedures;

cardiac pacemaker revision except device replacement;

other circulatory system operating room procedures;

acute myocardial infarction;

circulatory disorders except acute myocardial infarction, with cardiac catheterization;

heart failure and shock;

deep vein thrombophlebitis;

dehydration;

diversion diagnosis;

end-stage disease states;

external feeding;

New York Heart Association class IV heart failure;

severe/symptomatic valvular heart disease in individuals who are poor surgical candidates;

Global Initiative for Chronic Obstructive Lung Disease classification stage IV COPD/respiratory failure;

malignant disease;

failure to thrive of senescence;

acquired immunodeficiency syndrome (AIDS);

cirrhosis in individuals who are not candidates for transplantation;

amyotrophic lateral sclerosis;

peripheral vascular disorders;

atherosclerosis;

hypertension;

cardiac arrhythmia and conduction disorders;

syncope and collapse;

chest pain;

other circulatory system diagnoses;

diverticulitis;

post-operative central nervous system procedures;

strokes;

neoplasms and lymphoma-related hospitalizations;

chronic infections;

stomach, esophageal and duodenal procedures;

major small and large bowel procedures with other digestive system operating room procedures;

peritoneal adhesiolysis;

hernia procedures except inguinal and femoral;

other digestive system operating room procedures;

major gastrointestinal disorders and peritoneal infection;

digestive malignancy;

gastrointestinal hemorrhage;

complicated peptic ulcer;

gastrointestinal obstruction;

esophagitis, gastroenterological and miscellaneous digestive disorders;

other digestive system diagnoses;

laparoscopic cholecystectomy without common bile duct exploration;

cirrhosis and alcoholic hepatitis;

malignancy of hepatobiliary system or pancreas;

disorders of pancreas except malignancy;

disorders of liver except malignancy, cirrhosis, alcoholic hepatitis;

disorders of the biliary tract;

spinal fusion except cervical;

wound debridement and skin graft except hand, for musculoskeletal-connective tissue;

revision of hip or knee replacement;

major joint replacement or reattachment of lower extremity;

hip and femur procedures except major joint;

knee procedures with past diagnosis of infection;

back and neck procedures except spinal fusion or disctectomy;

lower extremety and humer procedures except hip, foot, femur;

other musculoskeletal system and connective tissue operating room procedures;

fractures of hip and pelvis;

osteomyelitis;

pathological fractures and musculoskeletal and connective tissue fractures, sprains, strains and dislocations except femur, hip, pelvis and skin graft and/or debridement for skin ulceration or cellulitis;

connective tissue disorders;

medical back problems;

tendonitis, myositis and bursitis;

fracture, sprain, strain and dislocation except femur, hip, and pelvis;

skin graft and/or debridement for skin ulcer or cellulitis;

other skin, subcutaneous tissue and breast procedures;

skin ulcers;

cellulitis;

skin grafts and wound debridement for endocrine, nutrition, and metabolic disorders;

other endocrine, nutrition and metabolic operating room procedures;

diabetes;

nutritional and miscellaneous metabolic disorders;

endocrine disorders;

major bladder procedures;

kidney and ureter procedures for neoplasm;

transurethral procedures;

other kidney and urinary tract procedures;

renal failure;

kidney and urinary tract infections;

urinary stones without electronic shockwave lithotripsy;

other kidney and urinary tract diagnoses;

major male pelvic procedures, conization, laparoscopy and tubal interruption;

other female reproductive system operating procedures;

lymphoma and non-acute leukemia;

infectious and parasitic diseases with operating room procedure;

postoperative or post-traumatic infections within operating rooms;

fever;

viral illness;

septicemia or severe sepsis without mechanical ventilation for at least 96 hours;

poisoning and toxic effects of drugs;

complications of treatment;

signs and symptoms;

HIV with major related conditions;

extensive operating room procedure unrelated to principal disorder; and

non-extensive operating room procedure unrelated to principal disorder.

5. The de-centralized healthcare system of claim 1, wherein the de-centralized healthcare system affiliates, collaborates, communicates, or cooperates with at least one conventional healthcare facility.

6. The de-centralized healthcare system of claim 1, wherein each care pathway protocol comprises:

a) subject qualification and admission, comprising;

1) stability criteria, comprising;

subject status, psychological and social safety status; and

2) assessments, comprising;

subject'"'"'s health, home assessments, and nutritional needs;

b) orders, treatments, and activities, comprising;

medications, subject activities, nutritional supplementation, procedures, durable medical equipment, and optionally interventions effective to improve the health of the subject;

c) monitoring, comprising;

biometric and telecommunication equipment to monitor the subject;

d) education and care coordination/integration, comprising;

instructive exercises and literature; and

e) advanced medical directive, comprising;

discussions regarding one or both of chronic care management and advanced care planning.

7. The de-centralized healthcare system of claim 1, wherein the central station is staffed by at least two healthcare practitioners.

8. The de-centralized healthcare system of claim 1, wherein the healthcare practitioner is a doctor of medicine, a doctor of osteopathy, or a nurse practitioner.

9. The de-centralized healthcare system of claim 1, wherein the healthcare practitioner is available by appointment, on-call, or for emergencies.

10. The de-centralized healthcare system of claim 1, wherein the healthcare practitioner provides a healthcare service to the subject.

11. The de-centralized healthcare system of claim 1, wherein the subject comprises a designated health condition.

12. The de-centralized healthcare system of claim 1, wherein the healthcare practitioner is a veterinarian.

13. The de-centralized healthcare system of claim 12, wherein the subject is the owner of an animal.

14. The de-centralized healthcare system of claim 13, wherein the animal is in need of healthcare or the owner is in of want of healthcare for the animal.

15. The de-centralized healthcare system of claim 14, wherein the animal is a pet, a guardian, a livestock, a service animal, a show animal, a working animal, a racing animal, or a breeding animal.

16. The de-centralized healthcare system of claim 14, wherein the animal is a mammal, a reptile, a bird, an amphibian, or an aquatic animal.

17. The de-centralized healthcare system of claim 1, wherein the subject resides at a private home, a nursing home, an apartment, a hotel, or an assisted-living facility.

18. The de-centralized healthcare system of claim 1, wherein the subject does not leave home to receive healthcare service.

19. The de-centralized healthcare system of claim 1, wherein the subject requests a healthcare service via the communication system.

20. The de-centralized healthcare system of claim 19, wherein the healthcare service comprises an advice, an instruction, or a recommendation.

21. The de-centralized healthcare system of claim 1, wherein the subject is educated in self-administration of a healthcare procedure, wherein the healthcare procedure comprises a self-injection of an injectable material, a self-medication with a medication, a self-application of a topical material, a self-examination, a use of a device, a physical therapy, or a collection of a bodily fluid, a tissue or a discharge.

22. The de-centralized healthcare system of claim 21, wherein the healthcare procedure comprises the use of a kit provided by the de-centralized healthcare system.

23. The de-centralized healthcare system of claim 1, wherein the subject is at or near the end-of-life.

24. The de-centralized healthcare system of claim 1, wherein each care pathway protocol of the plurality of care pathway protocols is effective to provide healthcare to the subject for one or more designated health conditions.

25. The de-centralized healthcare system of claim 24, wherein each designated health condition has at least one care pathway protocol.

26. The de-centralized healthcare system of claim 24, wherein each of the care pathway protocols is used independently.

27. The de-centralized healthcare system of claim 1, wherein the healthcare practitioner performs at least one of the care pathway protocols.

28. The de-centralized healthcare system of claim 1, wherein more than one care pathway protocols are used synergistically.

29. The de-centralized healthcare system of claim 1, wherein the healthcare practitioner diagnoses, evaluates, or assesses the subject via the communication system.

30. The de-centralized healthcare system of claim 1, wherein the communication system comprises one or more of written, audio, visual, monitoring, and audio/visual communication.

31. The de-centralized healthcare system of claim 1, wherein the healthcare practitioner provides a healthcare service to the subject via the communication system.

32. The de-centralized healthcare system of claim 31, wherein the healthcare service comprises one or more of an advice, an instruction, a recommendation, an inquiry, or a prescription.

33. The de-centralized healthcare system of claim 1, further comprising a dispatch system.

34. The de-centralized healthcare system of claim 33, wherein the dispatch system is located at the same facility as the central station.

35. The de-centralized healthcare system of claim 33, wherein the dispatch system is located at a different facility than the central station.

36. The de-centralized healthcare system of claim 33, wherein the dispatch system is staffed by at least one healthcare provider.

37. The de-centralized healthcare system of claim 36, wherein the healthcare provider is a physician, a clinician, a nurse, a paramedic, a therapist, a pharmacist, or a veterinarian.

38. The de-centralized healthcare system of claim 37, wherein the physician is a doctor of medicine, osteopathy, chiropractic, podiatry, optometry, or dentistry.

39. The de-centralized healthcare system of claim 36, wherein the dispatch system dispatches the healthcare provider to the subject, wherein the subject is in need or want of healthcare.

40. The de-centralized healthcare system of claim 39, wherein the healthcare provider provides a healthcare service to the subject according to a care pathway protocol.

41. The de-centralized healthcare system of claim 39, wherein the subject requests that the dispatch system dispatch the healthcare provider to the subject.

42. The de-centralized healthcare system of claim 41, wherein the subject requests an emergency healthcare service.

43. The de-centralized healthcare system of claim 39, wherein the subject had not previously requested that the dispatch system dispatch the healthcare provider to the subject.

44. The de-centralized healthcare system of claim 43, wherein a monitoring device alerts the central station to a need for the emergency healthcare service.

45. The de-centralized healthcare system of claim 33, further comprising a plurality of kits, wherein each kit independently comprises materials effective for self-administration of a healthcare service.

46. The de-centralized healthcare system of claim 45, further comprising a laboratory.

47. The de-centralized healthcare system of claim 46, wherein the laboratory comprises facilities for performing an analysis of a sample provided by the subject.

48. The de-centralized healthcare system of claim 46, further comprising a hygiene system.

49. The de-centralized healthcare system of claim 48, wherein the hygiene system is staffed by at least one hygienist, wherein the hygienist enters the residence of the subject to perform one or more hygiene duties.

50. The de-centralized healthcare system of claim 49, wherein the subject is incapable of performing the hygiene duties.

51. The de-centralized healthcare system of claim 49, wherein the hygienist enters the residence of the subject daily, semi-weekly, weekly, biweekly, or monthly.

52. The de-centralized healthcare system of claim 49, wherein the hygiene duties comprise laundry, cleaning bed sheets, sanitizing, and disinfecting.

53. The de-centralized healthcare system of claim 48, further comprising a food delivery system.

54. The de-centralized healthcare system of claim 53, wherein the subject is incapable of providing food for the subject.

55. The de-centralized healthcare system of claim 53, wherein the food delivery system provides daily, semi-weekly, weekly, bi-weekly, or monthly delivery of a food supply.

56. The de-centralized healthcare system of claim 55, wherein the food supply comprises one or more of prepared meals, packaged foods, frozen foods, groceries, nutritional supplements, and foods comprising a nutritional regimen.

57. A method of providing healthcare, the method comprising:

a) providing a central station for the management of a de-centralized healthcare system, wherein the central station is staffed by at least one healthcare practitioner;

b) registering a subject in the de-centralized healthcare system, wherein the subject comprises a designated health condition;

c) providing the subject with means for a self-administered healthcare procedure; and

d) providing a communication system comprising communication between the subject and the central station, whereby the healthcare practitioner advises the subject on performing the self-administered healthcare procedure according to a care pathway protocol,

wherein the subject resides at a location remote from the central station.

58. The method of claim 57, wherein the designated health condition comprises one or more of:

heart transplant or implant of heart assist system;

craniotomy and endovascular intracranial procedures;

extracranial procedures;

multiple sclerosis and cerebellar ataxia;

intracranial hemorrhage or cerebral infarction;

transient ischemia;

nonspecific cerebrovascular disorders;

seizures;

headaches;

disequilibrium (vertigo);

major chest procedures;

other respiratory system operating room procedures;

pulmonary embolism;

respiratory infections and inflammations;

respiratory neoplasms;

pulmonary edema and respiratory failure;

chronic obstructive pulmonary disease;

simple pneumonia and pleurisy;

bronchitis and asthma;

respiratory signs and symptoms;

respiratory system diagnosis with ventilator support;

deep venous thrombosis, chronic heart failure;

cardiac valve and other major cardiothoracic procedures;

cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction/heart failure/shock;

cardiac defibrillator implant without cardiac catheterization with major coronary bypass with percutaneous transluminal coronary angioplasty;

major cardiovascular procedures or thoracic aorta;

permanent cardiac pacemaker implant;

percutaneous cardiovascular procedure with drug-eluting stent or other circulatory system operating room procedures;

other vascular procedures;

cardiac pacemaker revision except device replacement;

other circulatory system operating room procedures;

acute myocardial infarction;

circulatory disorders except acute myocardial infarction, with cardiac catheterization;

heart failure and shock;

deep vein thrombophlebitis;

dehydration;

diversion diagnosis;

end-stage disease states;

external feeding;

New York Heart Association class IV heart failure;

severe/symptomatic valvular heart disease in individuals who are poor surgical candidates;

Global Initiative for Chronic Obstructive Lung Disease classification stage IV COPD/respiratory failure;

malignant disease;

failure to thrive of senescence;

acquired immunodeficiency syndrome (AIDS);

cirrhosis in individuals who are not candidates for transplantation;

amyotrophic lateral sclerosis;

peripheral vascular disorders;

atherosclerosis;

hypertension;

cardiac arrhythmia and conduction disorders;

syncope and collapse;

chest pain;

other circulatory system diagnoses;

diverticulitis;

post-operative central nervous system procedures;

strokes;

neoplasms and lymphoma-related hospitalizations;

chronic infections;

stomach, esophageal and duodenal procedures;

major small and large bowel procedures with other digestive system operating room procedures;

peritoneal adhesiolysis;

hernia procedures except inguinal and femoral;

other digestive system operating room procedures;

major gastrointestinal disorders and peritoneal infection;

digestive malignancy;

gastrointestinal hemorrhage;

complicated peptic ulcer;

gastrointestinal obstruction;

esophagitis, gastroenterological and miscellaneous digestive disorders;

other digestive system diagnoses;

laparoscopic cholecystectomy without common bile duct exploration;

cirrhosis and alcoholic hepatitis;

malignancy of hepatobiliary system or pancreas;

disorders of pancreas except malignancy;

disorders of liver except malignancy, cirrhosis, alcoholic hepatitis;

disorders of the biliary tract;

spinal fusion except cervical;

wound debridement and skin graft except hand, for musculoskeletal-connective tissue;

revision of hip or knee replacement;

major joint replacement or reattachment of lower extremity;

hip and femur procedures except major joint;

knee procedures with past diagnosis of infection;

back and neck procedures except spinal fusion or disctectomy;

lower extremety and humer procedures except hip, foot, femur;

other musculoskeletal system and connective tissue operating room procedures;

fractures of hip and pelvis;

osteomyelitis;

pathological fractures and musculoskeletal and connective tissue fractures, sprains, strains and dislocations except femur, hip, pelvis and skin graft and/or debridement for skin ulceration or cellulitis;

connective tissue disorders;

medical back problems;

tendonitis, myositis and bursitis;

fracture, sprain, strain and dislocation except femur, hip, and pelvis;

skin graft and/or debridement for skin ulcer or cellulitis;

other skin, subcutaneous tissue and breast procedures;

skin ulcers;

cellulitis;

skin grafts and wound debridement for endocrine, nutrition, and metabolic disorders;

other endocrine, nutrition and metabolic operating room procedures;

diabetes;

nutritional and miscellaneous metabolic disorders;

endocrine disorders;

major bladder procedures;

kidney and ureter procedures for neoplasm;

transurethral procedures;

other kidney and urinary tract procedures;

renal failure;

kidney and urinary tract infections;

urinary stones without electronic shockwave lithotripsy;

other kidney and urinary tract diagnoses;

major male pelvic procedures, conization, laparoscopy and tubal interruption;

other female reproductive system operating procedures;

lymphoma and non-acute leukemia;

infectious and parasitic diseases with operating room procedure;

postoperative or post-traumatic infections within operating rooms;

fever;

viral illness;

septicemia or severe sepsis without mechanical ventilation for at least 96 hours;

poisoning and toxic effects of drugs;

complications of treatment;

signs and symptoms;

HIV with major related conditions;

extensive operating room procedure unrelated to principal disorder; and

non-extensive operating room procedure unrelated to principal disorder.

59. The method of claim 57, wherein the subject resides at a private home, a nursing home, an apartment, a hotel, or an assisted-living facility.

60. The method of claim 57, wherein the self-administered healthcare procedure comprises one or more of a medical regimen, an exercise regimen, a nutritional regimen, a mental aptitude regimen, a morale regimen, a hygiene regimen, a self-injection of an injectable material, a self-medication with a medication, a self-application of a topical material, a self-examination, a use of a device, a physical therapy, or a collection of a bodily fluid, a tissue or a discharge.

61. The method of claim 57, wherein the communication system comprises written, audio, visual, monitoring, or audio/visual communication, or a combination thereof.

62. The method of claim 57, wherein the healthcare practitioner diagnoses, evaluates, or assesses the subject via the communication system.

63. The method of claim 57, wherein the care pathway protocol comprises:

a) subject qualification and admission, comprising;

1) stability criteria, comprising;

subject status, psychological and social safety status; and

2) assessments, comprising;

subject'"'"'s health, home assessments, and nutritional needs;

b) orders, treatments, and activities, comprising;

medications, subject activities, nutritional supplementation, procedures, durable medical equipment, and optionally interventions effective to improve the health of the subject;

c) monitoring, comprising;

biometric and telecommunication equipment to monitor the subject;

d) education and care coordination/integration, comprising;

instructive exercises and literature; and

e) advanced medical directive, comprising;

discussions regarding one or both of chronic care management and advanced care planning.

64. The method of claim 57, further comprising providing at-home healthcare to the subject wherein the subject is in need or want of at-home healthcare.

65. The method of claim 64, wherein the subject requests at-home healthcare.

66. The method of claim 64, wherein a device alerts the central station to a need for at-home healthcare.

67. The method of claim 57, further comprising:

a) providing a dispatch system staffed by at least one healthcare provider;

b) dispatching the healthcare provider from the dispatch system to the subject, wherein the subject is in need or want of healthcare; and

c) administering a healthcare service to the subject via the healthcare provider according to a care pathway protocol.

68. The method of claim 67, wherein the healthcare provider is a physician, a clinician, a nurse, a paramedic, a therapist, a pharmacist, or a veterinarian.

69. The method of claim 68, wherein the physician is a doctor of medicine, osteopathy, chiropractic, podiatry, optometry, or dentistry.

70. A method of providing at-home healthcare, the method comprising:

a) providing a central station for the management of a de-centralized healthcare system;

b) providing a dispatch system staffed by at least one healthcare provider;

c) registering a subject in the de-centralized healthcare system, wherein the subject comprises a designated health condition;

d) providing a communication system comprising audio/visual communication between the subject and the central station, optionally whereby the subject requests healthcare;

e) optionally providing one or more devices and durable medical equipment to the home of the subject, wherein the devices are effective to alert the central station to a need for at-home healthcare;

f) dispatching the healthcare provider from the dispatch system to the subject, wherein the subject is in need or want of healthcare; and

g) administering a healthcare service to the subject via the healthcare provider according to a care pathway protocol.

71. A method of selecting a subject for a de-centralized healthcare system, the method comprising:

a) providing a subject comprising a condition;

b) providing a list comprising a plurality of designated health conditions;

c) diagnosing the condition of the subject to provide a diagnosed condition;

d) comparing the diagnosed condition to the list comprising a plurality of designated health conditions;

e) selecting a subject based on the results of step d) to provide a selected subject; and

f) registering the selected subject in the de-centralized healthcare system to provide a registered subject,

wherein the de-centralized healthcare system comprises;

1) a central station staffed by at least one healthcare practitioner;

2) a plurality of care pathway protocols, wherein each care pathway protocol comprises a protocol for providing healthcare for a selected designated health condition; and

3) a communication system for communication between the registered subject and the healthcare practitioner,

wherein the registered subject resides at a location remote from the central station.

72. The method of claim 71, wherein the designated health condition comprises one or more of:

heart transplant or implant of heart assist system;

craniotomy and endovascular intracranial procedures;

extracranial procedures;

multiple sclerosis and cerebellar ataxia;

intracranial hemorrhage or cerebral infarction;

transient ischemia;

nonspecific cerebrovascular disorders;

seizures;

headaches;

disequilibrium (vertigo);

major chest procedures;

other respiratory system operating room procedures;

pulmonary embolism;

respiratory infections and inflammations;

respiratory neoplasms;

pulmonary edema and respiratory failure;

chronic obstructive pulmonary disease;

simple pneumonia and pleurisy;

bronchitis and asthma;

respiratory signs and symptoms;

respiratory system diagnosis with ventilator support;

deep venous thrombosis, chronic heart failure;

cardiac valve and other major cardiothoracic procedures;

cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction/heart failure/shock;

cardiac defibrillator implant without cardiac catheterization with major coronary bypass with percutaneous transluminal coronary angioplasty;

major cardiovascular procedures or thoracic aorta;

permanent cardiac pacemaker implant;

percutaneous cardiovascular procedure with drug-eluting stent or other circulatory system operating room procedures;

other vascular procedures;

cardiac pacemaker revision except device replacement;

other circulatory system operating room procedures;

acute myocardial infarction;

circulatory disorders except acute myocardial infarction, with cardiac catheterization;

heart failure and shock;

deep vein thrombophlebitis;

dehydration;

diversion diagnosis;

end-stage disease states;

external feeding;

New York Heart Association class IV heart failure;

severe/symptomatic valvular heart disease in individuals who are poor surgical candidates;

Global Initiative for Chronic Obstructive Lung Disease classification stage IV COPD/respiratory failure;

malignant disease;

failure to thrive of senescence;

acquired immunodeficiency syndrome (AIDS);

cirrhosis in individuals who are not candidates for transplantation;

amyotrophic lateral sclerosis;

peripheral vascular disorders;

atherosclerosis;

hypertension;

cardiac arrhythmia and conduction disorders;

syncope and collapse;

chest pain;

other circulatory system diagnoses;

diverticulitis;

post-operative central nervous system procedures;

strokes;

neoplasms and lymphoma-related hospitalizations;

chronic infections;

stomach, esophageal and duodenal procedures;

major small and large bowel procedures with other digestive system operating room procedures;

peritoneal adhesiolysis;

hernia procedures except inguinal and femoral;

other digestive system operating room procedures;

major gastrointestinal disorders and peritoneal infection;

digestive malignancy;

gastrointestinal hemorrhage;

complicated peptic ulcer;

gastrointestinal obstruction;

esophagitis, gastroenterological and miscellaneous digestive disorders;

other digestive system diagnoses;

laparoscopic cholecystectomy without common bile duct exploration;

cirrhosis and alcoholic hepatitis;

malignancy of hepatobiliary system or pancreas;

disorders of pancreas except malignancy;

disorders of liver except malignancy, cirrhosis, alcoholic hepatitis;

disorders of the biliary tract;

spinal fusion except cervical;

wound debridement and skin graft except hand, for musculoskeletal-connective tissue;

revision of hip or knee replacement;

major joint replacement or reattachment of lower extremity;

hip and femur procedures except major joint;

knee procedures with past diagnosis of infection;

back and neck procedures except spinal fusion or disctectomy;

lower extremety and humer procedures except hip, foot, femur;

other musculoskeletal system and connective tissue operating room procedures;

fractures of hip and pelvis;

osteomyelitis;

pathological fractures and musculoskeletal and connective tissue fractures, sprains, strains and dislocations except femur, hip, pelvis and skin graft and/or debridement for skin ulceration or cellulitis;

connective tissue disorders;

medical back problems;

tendonitis, myositis and bursitis;

fracture, sprain, strain and dislocation except femur, hip, and pelvis;

skin graft and/or debridement for skin ulcer or cellulitis;

other skin, subcutaneous tissue and breast procedures;

skin ulcers;

cellulitis;

skin grafts and wound debridement for endocrine, nutrition, and metabolic disorders;

other endocrine, nutrition and metabolic operating room procedures;

diabetes;

nutritional and miscellaneous metabolic disorders;

endocrine disorders;

major bladder procedures;

kidney and ureter procedures for neoplasm;

transurethral procedures;

other kidney and urinary tract procedures;

renal failure;

kidney and urinary tract infections;

urinary stones without electronic shockwave lithotripsy;

other kidney and urinary tract diagnoses;

major male pelvic procedures, conization, laparoscopy and tubal interruption;

other female reproductive system operating procedures;

lymphoma and non-acute leukemia;

infectious and parasitic diseases with operating room procedure;

postoperative or post-traumatic infections within operating rooms;

fever;

viral illness;

septicemia or severe sepsis without mechanical ventilation for at least 96 hours;

poisoning and toxic effects of drugs;

complications of treatment;

signs and symptoms;

HIV with major related conditions;

extensive operating room procedure unrelated to principal disorder; and

non-extensive operating room procedure unrelated to principal disorder.

73. A method of selecting a subject for a de-centralized healthcare system, the method comprising:

a) providing a subject comprising a condition;

b) diagnosing the condition of the subject to provide a diagnosed condition;

c) performing a cost/benefit analysis for caring for the subject in a hospital system;

d) performing a cost/benefit analysis for caring for the subject in the de-centralized healthcare system;

e) comparing the results of steps c) and d);

f) selecting a subject based on the results of step e) to provide a selected subject; and

g) registering the selected subject in the de-centralized healthcare system to provide a registered subject,

wherein the de-centralized healthcare system comprises;

1) a central station staffed by at least one healthcare practitioner;

2) a plurality of care pathway protocols, wherein each care pathway protocol comprises a protocol for providing healthcare for a selected designated health condition; and

3) a communication system for communication between the registered subject and the healthcare practitioner,

wherein the registered subject resides at a location remote from the central station.

74. A care pathway protocol, comprising:

a) subject qualification and admission, comprising;

1) stability criteria, comprising;

subject status, psychological and social safety status; and

2) assessments, comprising;

subject'"'"'s health, home assessments, and nutritional needs;

b) orders, treatments, and activities, comprising;

medications, subject activities, nutritional supplementation, procedures, durable medical equipment, and optionally interventions effective to improve the health of the subject;

c) monitoring, comprising;

biometric and telecommunication equipment to monitor the subject;

d) education and care coordination/integration, comprising;

instructive exercises and literature; and

e) advanced medical directive, comprising;

discussions regarding one or both of chronic care management and advanced care planning.

75. The care pathway protocol of claim 74, wherein the care pathway protocol is effective to provide therapy for one or more of:

heart transplant or implant of heart assist system;

craniotomy and endovascular intracranial procedures;

extracranial procedures;

multiple sclerosis and cerebellar ataxia;

intracranial hemorrhage or cerebral infarction;

transient ischemia;

nonspecific cerebrovascular disorders;

seizures;

headaches;

disequilibrium (vertigo);

major chest procedures;

other respiratory system operating room procedures;

pulmonary embolism;

respiratory infections and inflammations;

respiratory neoplasms;

pulmonary edema and respiratory failure;

chronic obstructive pulmonary disease;

simple pneumonia and pleurisy;

bronchitis and asthma;

respiratory signs and symptoms;

respiratory system diagnosis with ventilator support;

deep venous thrombosis, chronic heart failure;

cardiac valve and other major cardiothoracic procedures;

cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction/heart failure/shock;

cardiac defibrillator implant without cardiac catheterization with major coronary bypass with percutaneous transluminal coronary angioplasty;

major cardiovascular procedures or thoracic aorta;

permanent cardiac pacemaker implant;

percutaneous cardiovascular procedure with drug-eluting stent or other circulatory system operating room procedures;

other vascular procedures;

cardiac pacemaker revision except device replacement;

other circulatory system operating room procedures;

acute myocardial infarction;

circulatory disorders except acute myocardial infarction, with cardiac catheterization;

heart failure and shock;

deep vein thrombophlebitis;

dehydration;

diversion diagnosis;

end-stage disease states;

external feeding;

New York Heart Association class IV heart failure;

severe/symptomatic valvular heart disease in individuals who are poor surgical candidates;

Global Initiative for Chronic Obstructive Lung Disease classification stage IV COPD/respiratory failure;

malignant disease;

failure to thrive of senescence;

acquired immunodeficiency syndrome (AIDS);

cirrhosis in individuals who are not candidates for transplantation;

amyotrophic lateral sclerosis;

peripheral vascular disorders;

atherosclerosis;

hypertension;

cardiac arrhythmia and conduction disorders;

syncope and collapse;

chest pain;

other circulatory system diagnoses;

diverticulitis;

post-operative central nervous system procedures;

strokes;

neoplasms and lymphoma-related hospitalizations;

chronic infections;

stomach, esophageal and duodenal procedures;

major small and large bowel procedures with other digestive system operating room procedures;

peritoneal adhesiolysis;

hernia procedures except inguinal and femoral;

other digestive system operating room procedures;

major gastrointestinal disorders and peritoneal infection;

digestive malignancy;

gastrointestinal hemorrhage;

complicated peptic ulcer;

gastrointestinal obstruction;

esophagitis, gastroenterological and miscellaneous digestive disorders;

other digestive system diagnoses;

laparoscopic cholecystectomy without common bile duct exploration;

cirrhosis and alcoholic hepatitis;

malignancy of hepatobiliary system or pancreas;

disorders of pancreas except malignancy;

disorders of liver except malignancy, cirrhosis, alcoholic hepatitis;

disorders of the biliary tract;

spinal fusion except cervical;

wound debridement and skin graft except hand, for musculoskeletal-connective tissue;

revision of hip or knee replacement;

major joint replacement or reattachment of lower extremity;

hip and femur procedures except major joint;

knee procedures with past diagnosis of infection;

back and neck procedures except spinal fusion or disctectomy;

lower extremety and humer procedures except hip, foot, femur;

other musculoskeletal system and connective tissue operating room procedures;

fractures of hip and pelvis;

osteomyelitis;

pathological fractures and musculoskeletal and connective tissue fractures, sprains, strains and dislocations except femur, hip, pelvis and skin graft and/or debridement for skin ulceration or cellulitis;

connective tissue disorders;

medical back problems;

tendonitis, myositis and bursitis;

fracture, sprain, strain and dislocation except femur, hip, and pelvis;

skin graft and/or debridement for skin ulcer or cellulitis;

other skin, subcutaneous tissue and breast procedures;

skin ulcers;

cellulitis;

skin grafts and wound debridement for endocrine, nutrition, and metabolic disorders;

other endocrine, nutrition and metabolic operating room procedures;

diabetes;

nutritional and miscellaneous metabolic disorders;

endocrine disorders;

major bladder procedures;

kidney and ureter procedures for neoplasm;

transurethral procedures;

other kidney and urinary tract procedures;

renal failure;

kidney and urinary tract infections;

urinary stones without electronic shockwave lithotripsy;

other kidney and urinary tract diagnoses;

major male pelvic procedures, conization, laparoscopy and tubal interruption;

other female reproductive system operating procedures;

lymphoma and non-acute leukemia;

infectious and parasitic diseases with operating room procedure;

postoperative or post-traumatic infections within operating rooms;

fever;

viral illness;

septicemia or severe sepsis without mechanical ventilation for at least 96 hours;

poisoning and toxic effects of drugs;

complications of treatment;

signs and symptoms;

HIV with major related conditions;

extensive operating room procedure unrelated to principal disorder; and

non-extensive operating room procedure unrelated to principal disorder.

76. A method of providing acute healthcare, the method comprising:

a) qualifying and admitting a subject, comprising;

1) evaluating the subject'"'"'s stability criteria, comprising the subject'"'"'s status, and psychological and social safety status; and

2) assessing the subject'"'"'s health, home, and nutritional needs;

b) issuing orders, treatments, and activities for the subject, comprising;

medications, subject activities, nutritional supplementation, procedures, durable medical equipment, and optionally interventions effective to improve the health of the subject;

c) monitoring the subject, comprising;

providing biometric and telecommunication equipment to monitor the subject and monitoring the subject with the biometric and telecommunication equipment;

d) educating the subject on care coordination/integration, the educating comprising;

instructive exercises and literature; and

e) providing an advanced medical directive, comprising;

discussing one or both of chronic care management and advanced care planning.

77. The method of claim 76, wherein the subject is in need or want of therapy for one or more of:

heart transplant or implant of heart assist system;

craniotomy and endovascular intracranial procedures;

extracranial procedures;

multiple sclerosis and cerebellar ataxia;

intracranial hemorrhage or cerebral infarction;

transient ischemia;

nonspecific cerebrovascular disorders;

seizures;

headaches;

disequilibrium (vertigo);

major chest procedures;

other respiratory system operating room procedures;

pulmonary embolism;

respiratory infections and inflammations;

respiratory neoplasms;

pulmonary edema and respiratory failure;

chronic obstructive pulmonary disease;

simple pneumonia and pleurisy;

bronchitis and asthma;

respiratory signs and symptoms;

respiratory system diagnosis with ventilator support;

deep venous thrombosis, chronic heart failure;

cardiac valve and other major cardiothoracic procedures;

cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction/heart failure/shock;

cardiac defibrillator implant without cardiac catheterization with major coronary bypass with percutaneous transluminal coronary angioplasty;

major cardiovascular procedures or thoracic aorta;

permanent cardiac pacemaker implant;

percutaneous cardiovascular procedure with drug-eluting stent or other circulatory system operating room procedures;

other vascular procedures;

cardiac pacemaker revision except device replacement;

other circulatory system operating room procedures;

acute myocardial infarction;

circulatory disorders except acute myocardial infarction, with cardiac catheterization;

heart failure and shock;

deep vein thrombophlebitis;

dehydration;

diversion diagnosis;

end-stage disease states;

external feeding;

New York Heart Association class IV heart failure;

severe/symptomatic valvular heart disease in individuals who are poor surgical candidates;

Global Initiative for Chronic Obstructive Lung Disease classification stage IV COPD/respiratory failure;

malignant disease;

failure to thrive of senescence;

acquired immunodeficiency syndrome (AIDS);

cirrhosis in individuals who are not candidates for transplantation;

amyotrophic lateral sclerosis;

peripheral vascular disorders;

atherosclerosis;

hypertension;

cardiac arrhythmia and conduction disorders;

syncope and collapse;

chest pain;

other circulatory system diagnoses;

diverticulitis;

post-operative central nervous system procedures;

strokes;

neoplasms and lymphoma-related hospitalizations;

chronic infections;

stomach, esophageal and duodenal procedures;

major small and large bowel procedures with other digestive system operating room procedures;

peritoneal adhesiolysis;

hernia procedures except inguinal and femoral;

other digestive system operating room procedures;

major gastrointestinal disorders and peritoneal infection;

digestive malignancy;

gastrointestinal hemorrhage;

complicated peptic ulcer;

gastrointestinal obstruction;

esophagitis, gastroenterological and miscellaneous digestive disorders;

other digestive system diagnoses;

laparoscopic cholecystectomy without common bile duct exploration;

cirrhosis and alcoholic hepatitis;

malignancy of hepatobiliary system or pancreas;

disorders of pancreas except malignancy;

disorders of liver except malignancy, cirrhosis, alcoholic hepatitis;

disorders of the biliary tract;

spinal fusion except cervical;

wound debridement and skin graft except hand, for musculoskeletal-connective tissue;

revision of hip or knee replacement;

major joint replacement or reattachment of lower extremity;

hip and femur procedures except major joint;

knee procedures with past diagnosis of infection;

back and neck procedures except spinal fusion or disctectomy;

lower extremety and humer procedures except hip, foot, femur;

other musculoskeletal system and connective tissue operating room procedures;

fractures of hip and pelvis;

osteomyelitis;

pathological fractures and musculoskeletal and connective tissue fractures, sprains, strains and dislocations except femur, hip, pelvis and skin graft and/or debridement for skin ulceration or cellulitis;

connective tissue disorders;

medical back problems;

tendonitis, myositis and bursitis;

fracture, sprain, strain and dislocation except femur, hip, and pelvis;

skin graft and/or debridement for skin ulcer or cellulitis;

other skin, subcutaneous tissue and breast procedures;

skin ulcers;

cellulitis;

skin grafts and wound debridement for endocrine, nutrition, and metabolic disorders;

other endocrine, nutrition and metabolic operating room procedures;

diabetes;

nutritional and miscellaneous metabolic disorders;

endocrine disorders;

major bladder procedures;

kidney and ureter procedures for neoplasm;

transurethral procedures;

other kidney and urinary tract procedures;

renal failure;

kidney and urinary tract infections;

urinary stones without electronic shockwave lithotripsy;

other kidney and urinary tract diagnoses;

major male pelvic procedures, conization, laparoscopy and tubal interruption;

other female reproductive system operating procedures;

lymphoma and non-acute leukemia;

infectious and parasitic diseases with operating room procedure;

postoperative or post-traumatic infections within operating rooms;

fever;

viral illness;

septicemia or severe sepsis without mechanical ventilation for at least 96 hours;

poisoning and toxic effects of drugs;

complications of treatment;

signs and symptoms;

HIV with major related conditions;

extensive operating room procedure unrelated to principal disorder; and

non-extensive operating room procedure unrelated to principal disorder.