About

Natalie M. Como, MD, is an Assistant Professor at the University of Utah Hospital as part of the Division of General Internal Medicine. She is a hospitalist whose research interests include medical education in rural settings, mentorship, and improving the delivery of rural healthcare. Dr. Como received her undergraduate degree at Duke University and her MD from Creighton University School of Medicine. She completed a combined residency training in Internal Medicine and Pediatrics at the University of Utah, where she served as the Chief Medical Resident. In addition to her work at the University of Utah Hospital, she works part time at the Community Hospital of Anaconda in Montana, a highly ranked rural critical access hospital, where she also precepts medical students as University of Washington School of Medicine WWAMI faculty.

Research topics

• Medicine
• Nursing
• Medical emergency
• Database
• Pathology
• Biology
• Economic growth
• Business
• Family medicine
• Emergency medicine

Selected publications

• Hospital-Level Care at Home for Acutely Ill Adults in Rural Settings

  Home Healthcare Now · 2024 · 5 citations

  • Medicine
  • Family medicine
  • Emergency medicine

  Residents in rural areas face barriers to accessing acute care. Rural home hospital (RHH) or delivery of acute care at home could represent an important clinical care model. This study assessed the feasibility and acceptability of RHH as a substitute to traditional hospital care. Patients were cared for by a remote RHH attending physician and an RHH registered nurse deployed to the home. The study team conducted daily check-ins with RHH clinicians to assess workflows for completion. Surveys assessed patient experience and qualitative interviews assessed perceived acceptability, safety, and quality of care. We completed qualitative analysis of the interviews and coded qualitative data into domains and subdomains through an iterative process. RHH was successfully deployed to three acutely ill patients in rural Utah. RHH admission, daily care, and discharge processes were accomplished for each patient. From qualitative analysis, we identified four domains: (1) Perceived comfort level during RHH admission, (2) Perceived safety during RHH admission, (3) Perceived quality of care during RHH admission, and (4) Perception of RHH workflows. We found acute care was delivered to rural homes with satisfactory patient and clinician experience. Team dynamics, technology build, robust clinical and operational workflows, and care coordination were important to a successful admission. Learnings from this study can inform program design and training for RHH teams and startup for larger RHH evaluation. Home hospital care is expanding rapidly in the United States and RHH could represent an important clinical care model.

  PublisherDOI

• Scoping and testing rural acute care at home: a simulation analysis

  BMJ Innovations · 2021 · 25 citations

  • Medicine
  • Medical emergency
  • Nursing

  Purpose Hospital-level care provided at home improves patient outcomes, yet nearly all programmes function in urban environments. It remains unknown whether rural home hospital care can be feasibly delivered. Methods Based on prior stakeholder learning and detailed landscape analyses of various rural areas across the country, we re-engineered the workflows, personnel and technology needed to respond to many of the challenges of delivering acute care in rural homes. We performed a preliminary ‘mock admission’ in a simulation laboratory with actor feedback, followed by mock admissions in rural homes in Utah of chronically ill patients who feigned acute illness. We employed rapid cycle feedback from clinicians, patients and their caregivers and qualitative analysis of participant feedback. Findings Following rapid cycle feedback in the simulation laboratory and rural homes, mock admission, daily rounds and discharge were successfully conducted. Technology performed to laboratory-determined specifications but presented challenges. Patients noted significant comfort with and preference for rural home hospital care, while clinicians also preferred the model with the caveat that proper patient selection was paramount. Patients and clinicians perceived rural home hospital as safe. Clinicians noted rural home hospital workflows were feasible after streamlining remote and in-home roles. Conclusions Rural home hospital care is technically feasible, well-received and desired. It requires testing with acutely ill adults in rural settings.

  PublisherDOI

• Rural Perceptions of Acute Care at Home: A Qualitative Analysis

  The Journal of Rural Health · 2021 · 47 citations

  • Medicine
  • Nursing
  • Business

  PURPOSE: Hospital-level care at home in urban areas delivers low-cost, high-quality care. Few have attempted to deliver home hospital care in a rural environment, where traditional hospitals are often less equipped to deliver high-quality care. Little is known about rural clinicians' and patients' perceptions regarding rural home hospital care and how the urban model might be adapted to fit rural circumstances. METHODS: We conducted semistructured qualitative interviews in the United States with a national purposive sample of practicing rural clinicians, a focus group with clinicians who care for rural patients, and interviews with rural patients. We coded these qualitative data into domains and subdomains. FINDINGS: We identified 4 domains: (1) current state of rural health care, (2) attitudes toward rural home hospital, (3) perceived barriers to implementing rural home hospital, and (4) perceived facilitators to implementing rural home hospital. Participants expressed challenges with current rural health care, including inefficient care coupled with poor access. Most felt rural home hospital care could offer benefits, including comfort, timeliness, and downstream outcomes such as readmission rate reduction. Rural patients were open to receiving acute care in their homes. Potential barriers included geographic accessibility, Internet connectivity, rural hospital politics, the culture of hospitalization, and the availability of skilled human resources. CONCLUSIONS: Significant interest and optimism exist surrounding rural home hospital despite perceived barriers. Designing for and testing adaptations to the urban model will likely optimize benefits and minimize threats to a potential intervention.

  PublisherDOI

• Implementation of an interprofessional learner team-based medication reconciliation and review in an Internal Medicine-Pediatrics resident continuity clinic

  Journal of Interprofessional Education & Practice · 2020-01-09 · 1 citations

  article
  PublisherDOI

• Mosby's home health nursing pocket consultant

  Mosby eBooks · 1995-01-01

  book1st authorCorresponding

  MOSBY'S HOME HEALTH NURSING POCKET CONSULTANT provides nurses with a collection of useful facts, tips and guidelines related to patient care in the home. Because home health nurses practice more independently and autonomously than nurses in any other setting, it is important for them to have a readily available reference to assist in unexpected situations.

  Publisher

Frequent coauthors

• David M. Levine

  Universitat de Barcelona

  10 shared

• Joseph B. Ross

  MetroHealth

  8 shared

• C Hernández

  Universitat de Barcelona

  6 shared

• Meghna Desai

  3 shared

• Clinton R Sheffield

  University of Utah

  1 shared

• Miranda Tracy

  Baylor Scott & White Medical Center - Temple

  1 shared

• Sean Christensen

  University of Utah

  1 shared

• Stephanie Blitzer

  Ariadne Diagnostics (United States)

  1 shared