Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Children's Minnesota's monitoring program can cut NICU stays by 6 days. Dr. Mark Bergeron discusses how.

Transcript

Children's Minnesota's monitoring program can cut NICU stays by 6 days. Dr. Mark Bergeron discusses how. · Becker’s Healthcare -- Pediatric Leadership Podcast

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  - This is Chris host with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr.
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  Mark Bergeron, medical Director
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  for Digital Health transformation,
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  and medical director for the Neonatal Virtual program care
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  program at Children's Minnesota.
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  He joins us today to discuss the health systems,
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  the kids experts at home monitoring program.
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  Dr. Bergeron, thank you so much
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  for being part of the podcast today.
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  - Hey, good morning Chris, and thanks for having me back.
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  - I know you've been on our podcast before,
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  but for those who may not be unfamiliar with you,
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  could you please introduce yourself
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  and tell us a bit about your background?
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  - Yeah, absolutely. So, I, uh, I, like you said,
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  I'm Mark Bergeron.
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  Uh, I'm medical director
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  for Digital Health Transformation at Children's Minnesota,
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  but I'm also a practicing neonatologist
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  and I've been at Children's, uh, Minnesota for, gosh,
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  just about 19 years.
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  Uh, uh, one of my duties is also as medical director
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  of our virtual care programs within
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  the neonatology division.
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  - As I mentioned, we're here to talk about the Kid Experts
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  at Home monitoring program.
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  So can you tell us how it develops and what program
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  or programs, if any, or uses models?
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  - Yeah, absolutely.
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  So just, uh, before we get started,
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  just a little bit about Children's Minnesota.
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  Our neonatology program, uh, is, uh, a vital resource, uh,
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  to our communities and region.
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  Um, and it's one of, it is the largest program in Minnesota
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  with a level four NICU
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  and two level three N ICUs plus, uh,
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  level two special care nurseries, um, making us one
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  of the biggest programs, uh, in the upper Midwest region.
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  Um, the kid Expert at Home Program, uh, kind
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  of came about as, you know, within our, our, uh,
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  our neonatology group, a sense of curiosity about, uh,
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  are there other care models that we should be exploring?
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  Um, and out of that,
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  and a, a real pinch for bed space
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  during respiratory surge months, uh, during winter,
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  we came up with this kind of early discharge program
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  where our kids go home, we are, uh,
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  rounding on them virtually.
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  Um, and they're still receiving, uh,
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  nasal gastric tube feedings administered by their parents.
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  And it, it's great
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  'cause it facilitates earlier discharge than what's
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  traditionally expected from a neonatology unit.
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  Um, and it, uh, gets these kids home where they should be.
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  - Certainly this is something that would need a bit
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  of training for both the
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  staff involved as well as the parents.
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  So what is involved in that process?
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  - Well, uh, from the first day ,
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  a baby is admitted to the neonatal units.
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  We're teaching the parents how to take care
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  of a preterm infant.
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  That doesn't change, but parents have time
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  and time again said that the, the slowest kind
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  of most frustrating part of the neonatal journey, uh,
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  to home is the last few weeks
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  and days when the infant has really no medical problems,
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  but just is slowly learning how to eat.
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  And so we sort of have modified our, uh,
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  discharge teaching for home process
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  to include tube feedings at home.
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  Traditionally, you would wait
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  until the infant had their feeding tube removed from their
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  nose and, and make sure they were gaining weight
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  and then discharge 'em to home.
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  We've sort of cut out that last part, uh,
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  from the hospital experience
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  and offered it to parents to do it at home.
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  So we teach them how to care for that, uh, nasogastric tube,
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  how to administer the feedings using a feeding pump.
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  Uh, we teach 'em how to use a, uh,
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  a monitoring application on a smartphone
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  or a pad to enter their daily weights,
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  their feeding volumes, um, their urine
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  and stool output, all those things
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  that we would be recording in the hospital
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  to make medical decisions.
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  And then we round virtually with the families, uh,
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  to make those decisions about
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  how the feedings are progressing, um,
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  and how soon to remove that, uh, feeding tube,
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  but doing it at home.
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  And then we teach the parents what to do if it comes out,
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  who to call, um, and support them that way.
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  - Gotcha. So can you describe this CASA program has had in
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  the Children's Minnesota community,
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  and are there plans to expand the program
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  beyond the three hospitals it currently serves?
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  - Yeah, absolutely. So I think, you know, we could,
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  it's been a resounding success.
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  It's shortened. Uh, you know, in our pilot study,
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  it shortened the expected hospital stay by about six days.
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  Uh, we saw the feedings, uh, uh, go better at home
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  as we kind of anticipated that they would,
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  and full oral feedings were established quicker at home
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  by several days, um, faster than
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  what we were experiencing traditionally in the hospital.
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  So we think those, those things are a resounding success.
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  We've had very few PE babies have to come back
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  for admission, uh, after discharge in the program.
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  And actually, in looking at those cases, they had nothing
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  to do with feedings and were other issues
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  that prompted the readmission to the hospital.
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  So we think it's successful, we think it's safe,
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  it's effective, and it's been a huge
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  satisfier for our families.
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  And during the height of Covid,
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  there was one patient in particular that struck us all, um,
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  and really characterizes the value of this program
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  that was Finn born at 32 weeks.
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  And, uh, during the height
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  of Covid when we were very restrictive about how many, uh,
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  visitors could come in, uh, uh, we had Finn
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  who was a perfect candidate for this program.
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  Uh, and his father was, uh, ending his, uh, battle with, uh,
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  pancreatic cancer and was not able to come
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  and see Finn in the hospital.
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  And we got Finn home quick on this program, uh,
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  and, uh, into where he should have been
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  with his, his parents.
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  And then, uh, his father ultimately passed away, uh,
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  not long after Finn's feeding Tube was removed,
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  and he was thriving at home.
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  And for, for all of us involved in his care, this was a win.
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  This was just a, a tremendous impact to our families
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  that we serve on, especially fins.
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  - Yeah. Wow. Dr. Bergan,
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  that's certainly a heartbreaking story,
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  but heartwarming in the fact that the father did get
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  to see his son for a little bit before he died.
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  I mean, wow. Yeah. Yeah.
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  Thankfully, yes, there are times when
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  that is considered a victory.
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  - Yeah. And, uh, so we want every family to, to have
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  that experience of getting their, their infant home as soon
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  as possible and, and thrive, uh, and, uh,
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  and we think that this is a great way to do that.
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  - Lastly, Dr. Bergon, it's a bit of a two part question.
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  Sure. So, what do you think is the next evolution
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  for kid experts at home?
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  And what other innovations does Children's Minnesota help
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  hope to launch in 2024 or the next few years?
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  - So we want as many babies to be, uh, suitable for this
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  or the program to be suitable for them as possible.
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  And the limitations of the technology
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  that we had when we launched the program was
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  that it was the, the application was
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  available in English only.
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  So we're now expanding that to Spanish.
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  And we we're working with our app vendor
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  to increase the number of languages offered.
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  Um, we use our own interpreter services for the, um,
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  virtual visits, but we want that app to be in, in, uh,
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  a usable language and format for all of our families.
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  So from an equity lens, that's probably our primary, uh,
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  focus, uh, this year.
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  And then, uh, we want the service to be more, you know, uh,
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  add value to our family's experience.
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  So we are adding virtual, uh, lactation consultations in
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  the kid expert at home program.
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  So one of our pediatric nurse practitioners
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  that works in our special care nursery will have virtual
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  visits, uh, with, um, uh, moms and their babies
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  after discharge to work on the lactation piece.
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  Um, so that we're really sending babies home with, uh,
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  successful, uh, breastfeeding, um, as a goal
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  and, uh, something that they can achieve.
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  And then looking into the future, we kind
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  of see the kid expert at home program as, as kind
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  of an early form of the hospital at home concept
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  that has been so wildly successful in the adult population.
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  And so, you know,
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  I guess in our journey towards a hospital at home care
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  model, this is our, our first baby step,
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  if you will, towards that.
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  Um, and really looking at other patients at Children's
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  Minnesota that could be suitable for, uh, um, kind
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  of a more advanced care at home.
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  - Dr. Berg, thank you so much for being so generous
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  with your time and insights today.
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  We definitely cannot wait to share them with our audience.
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  We look forward to connecting with you again soon.
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  - Hey, thanks Chris. I always appreciate the,
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  uh, opportunity to chat with you.
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