Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

Crystal Min Siu Chua, Stephanie Qianwen Ko, Yi Feng Lai, Yee Wei Lim, Shefaly Shorey, Crystal Min Siu Chua, Stephanie Qianwen Ko, Yi Feng Lai, Yee Wei Lim, Shefaly Shorey

Abstract

Background: Hospital-at-home (HaH) provides acute healthcare in patients' homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care.

Methodology: Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso's guidelines.

Results: Sixteen articles met the inclusion criteria. The overarching synthesized theme was "the intricacies of developing HaH," and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development.

Conclusion: Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges.

Keywords: caregivers; experience; healthcare administrators; healthcare professionals; hospital-at-home; patients; perceptions.

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

© 2021. Society of General Internal Medicine.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Themes and subthemes of the perceptions of HaH.

References

    1. Rossinot H, Marquestaut O, de Stampa M. The experience of patients and family caregivers during hospital-at-home in France. BMC health services research. 2019;19(1):470–470. doi: 10.1186/s12913-019-4295-7.
    1. Cryer L, Shannon SB, Amsterdam MV, Leff B. Costs For ‘Hospital At Home’ Patients Were 19 Percent Lower, With Equal Or Better Outcomes Compared To Similar Inpatients. Health affairs (Millwood, Va). 2012;31(6):1237. 10.1377/hlthaff.2011.1132.
    1. Leong MQ, Lim CW, Lai YF. Comparison of Hospital-at-Home models: a systematic review of reviews. BMJ open. 2021;11(1):e043285–e043285. doi: 10.1136/bmjopen-2020-043285.
    1. Pericàs JM, Cucchiari D, Torrallardona-Murphy O, et al. Hospital at home for the management of COVID-19: preliminary experience with 63 patients. 2020.
    1. Pericàs JM, Cucchiari D, Torrallardona-Murphy O, et al. Hospital at home for the management of COVID-19: preliminary experience with 63 patients. Infection. 2020:1-6. doi: 10.1007/s15010-020-01527-z.
    1. Heller DJ, Ornstein KA, DeCherrie LV, et al. Adapting a Hospital-at-Home Care Model to Respond to New York City’s COVID-19 Crisis. Journal of the American Geriatrics Society (JAGS). 2020;68(9):1915–1916. doi: 10.1111/jgs.16725.
    1. Qaddoura A, Yazdan-Ashoori P, Kabali C, et al. Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis. PloS one. 2015;10(6):e0129282–e0129282. doi: 10.1371/journal.pone.0129282.
    1. Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B. Hospital at home: home-based end-of-life care. Cochrane library. 2016;2016(2):CD009231–CD009231. doi: 10.1002/14651858.cd009231.pub2.
    1. Gonçalves-Bradley DC, Iliffe S, Doll HA, et al. Early discharge hospital at home. Cochrane library. 2017;2017(6):CD000356–CD000356. doi: 10.1002/14651858.CD000356.pub4.
    1. Levine DM, Ouchi K, Blanchfield B, et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Annals of internal medicine. 2020;172(2):77–85. doi: 10.7326/M19-0600.
    1. Hensher M, Fulop N, Hood S, Ujah S. Does hospital-at-home make economic sense ? Early discharge versus standard care for orthopaedic patients. Journal of the Royal Society of Medicine. 1996;89(10):548–551. doi: 10.1177/014107689608901003.
    1. Brody AA, Arbaje AI, DeCherrie LV, Federman AD, Leff B, Siu AL. Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation. Journal of the American Geriatrics Society (JAGS). 2019;67(3):588–595. doi: 10.1111/jgs.15782.
    1. Morano B, Jimenez-Mejia J, Sanon M, Morano C, DeCherrie LV. Acute Care in the Home Setting: Hospital at Home. Cham: Springer International Publishing; 2019. pp. 393–401.
    1. Sandelowski M, Barroso J. Classifying the Findings in Qualitative Studies. Qualitative health research. 2016;13(7):905–923. doi: 10.1177/1049732303253488.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P for the PG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339(7716):332–336. doi: 10.1136/bmj.b2535.
    1. Cahill M, Robinson K, Pettigrew J, Galvin R, Stanley M. Qualitative synthesis: A guide to conducting a meta-ethnography. Vol 81. London, England: SAGE Publications; 2018:129-137. 10.1177/0308022617745016.
    1. Hannes K, Lockwood C, Pearson A. A Comparative Analysis of Three Online Appraisal Instruments’ Ability to Assess Validity in Qualitative Research. Qualitative health research. 2010;20(12):1736-1743. doi: 10.1177/1049732310378656.
    1. Nadelson S, Nadelson LS. Evidence-Based Practice Article Reviews Using CASP Tools: A Method for Teaching EBP. Worldviews on evidence-based nursing. 2014;11(5):344–346. doi: 10.1111/wvn.12059.
    1. Butler A, Hall H, Copnell B. A Guide to Writing a Qualitative Systematic Review Protocol to Enhance Evidence-Based Practice in Nursing and Health Care. Worldviews on evidence-based nursing. 2016;13(3):241–249. doi: 10.1111/wvn.12134.
    1. Leung I, Casalino E, Pateron D, Grateau G, Garandeau E, de Stampa M. Participation of general practitioners in the management of their “hospital at home” patients. Santé publique (Vandoeuvre-lès-Nancy, France). 2016;28(4):499-504. 10.3917/spub.164.0499.
    1. Cœugnet S, Forrierre J, Naveteur J, Dubreucq C, Anceaux F. Time pressure and regulations on hospital-in-the-home (HITH) nurses: An on-the-road study. Applied Ergonomics. 2016;54:110–119. doi: 10.1016/j.apergo.2015.11.018.
    1. Cafazzo JA, Leonard K, Easty AC, Rossos PG, Chan CT. The user-centered approach in the development of a complex hospital-at home intervention. Studies in health technology and informatics. 2009;143:328–333. doi: 10.3233/978-1-58603-979-0-328.
    1. Cegarra-Navarro J-G, Wensley AKP, Sánchez-Polo M-T. An Application of the Hospital-in-the-Home Unlearning Context. Social work in health care. 2010;49(10):895–918. doi: 10.1080/00981389.2010.506410.
    1. Dismore L, Echevarria C, Van-Wersch A, Simpson AJ, Gibson GJ, Bourke SC. P213 Positive drivers and potential barriers to implementation of hospital at home selected by low risk decaf score. Thorax. 2016;71(Suppl 3):A201–A201. doi: 10.1136/thoraxjnl-2016-209333.356.
    1. Jester R. Early discharge to hospital at home: should it be a matter of choice? Journal of orthopaedic nursing. 2003;7(2):64–69. doi: 10.1016/S1361-3111(03)00003-7.
    1. Khalifeh H, Murgatroyd C, Freeman M, Johnson S, Killaspy H. Home Treatment as an Alternative to Hospital Admission for Mothers in a Mental Health Crisis: A Qualitative Study. Psychiatric Services. 2009;60(5):634–639. doi: 10.1176/ps.2009.60.5.634.
    1. Mäkelä P, Stott D, Godfrey M, Ellis G, Schiff R, Shepperd S. The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting. Age and ageing. 2020;49(5):856–864. doi: 10.1093/ageing/afaa085.
    1. Sims J, Rink E, Walker R, Pickard L. The introduction of a hospital at home service: A staff perspective. Journal of interprofessional care. 1997;11(2):217–224. doi: 10.3109/13561829709014913.
    1. Utens CMA, Goossens LMA, van Schayck OCP, et al. Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial. International journal of nursing studies. 2013;50(11):1537–1549. doi: 10.1016/j.ijnurstu.2013.03.006.
    1. Vaartio-Rajalin H, Ngoni K, Fagerström L. Balancing between extremes—Work in hospital-at-home. Nursing open. 2019;7(1):398–410. doi: 10.1002/nop2.402.
    1. Wang Y, Haugen T, Steihaug S, Werner A. Patients with acute exacerbation of chronic obstructive pulmonary disease feel safe when treated at home: a qualitative study. BMC pulmonary medicine. 2012;12(1):45–45. doi: 10.1186/1471-2466-12-45.
    1. Wilson A, Wynn A, Parker H. Patient and carer satisfaction with ‘hospital at home’: quantitative and qualitative results from a randomised controlled trial. British Journal of General Practice. 2002;52(474):9–13.
    1. Buchanan L, Clarke JL, Sulkowski AJ, et al. There’s no place like home: a prospective evaluation of chemotherapy in the home. The Australian journal of cancer nursing. 2003;4(1):18.
    1. Vaartio-Rajalin H, Fagerström L. Professional care at home: Patient-centredness, interprofessionality and effectivity? A scoping review. Health & social care in the community. 2019;27(4):e270–e288. doi: 10.1111/hsc.12731.
    1. McMillan SS, Kendall E, Sav A, et al. Patient-Centered Approaches to Health Care: A Systematic Review of Randomized Controlled Trials. Medical care research and review. 2013;70(6):567–596. doi: 10.1177/1077558713496318.
    1. Mercer SW, Neumann M, Wirtz M, Fitzpatrick B, Vojt G. General practitioner empathy, patient enablement, and patient-reported outcomes in primary care in an area of high socio-economic deprivation in Scotland—A pilot prospective study using structural equation modeling. Patient education and counseling. 2008;73(2):240–245. doi: 10.1016/j.pec.2008.07.022.
    1. Chen LM, Ayanian JZ. Care Continuity and Care Coordination: What Counts? JAMA internal medicine. 2014;174(5):749–750. doi: 10.1001/jamainternmed.2013.14331.
    1. Leff B, Burton L, Mader SL, et al. Comparison of Stress Experienced by Family Members of Patients Treated in Hospital at Home with That of Those Receiving Traditional Acute Hospital Care. Journal of the American Geriatrics Society (JAGS). 2008;56(1):117–123. doi: 10.1111/j.1532-5415.2007.01459.x.
    1. Lippert M, Semmens S, Tacey L, et al. The Hospital at Home program: no place like home. Current oncology (Toronto). 2017;24(1):23–27. doi: 10.3747/co.24.3326.
    1. Marcén M, Molina JA. Informal caring-time and caregiver satisfaction. The European journal of health economics. 2012;13(6):683–705. doi: 10.1007/s10198-011-0322-2.
    1. Goossens LMAP, Utens CMAP, Smeenk FWJMPMD, Donkers BP, van Schayck OCPP, Rutten-van Mölken MPMHP. Should I Stay or Should I Go Home? A Latent Class Analysis of a Discrete Choice Experiment on Hospital-At-Home. Value in health. 2014;17(5):588–596. doi: 10.1016/j.jval.2014.05.004.
    1. Haranath SP, Udayasankaran JG. Tele-intensive care unit networks: A viable means for augmenting critical care capacity in India for the COVID pandemic and beyond. Apollo Medicine. 2020;17(3):209. doi: 10.4103/am.am_104_20.
    1. Rezapour-Nasrabad R. Transitional care model: managing the experience of hospital at home. Electronic journal of general medicine. 2018;15(5). 10.29333/ejgm/93445.
    1. Jackson GL, Powers BJ, Gray R, et al. The Patient-Centered Medical Home: A Systematic Review. Annals of internal medicine. 2013;158(3):169–178. doi: 10.7326/0003-4819-158-3-201302050-00579.
    1. Leenen JPL, Leerentveld C, van Dijk JD, van Westreenen HL, Schoonhoven L, Patijn GA. Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review. Journal of medical Internet research. 2020;22(6):e18636–e18636. doi: 10.2196/18636.
    1. O’Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices. Journal of general internal medicine : JGIM. 2009;25(3):177–185. doi: 10.1007/s11606-009-1195-2.
    1. Saunders S, Killackey T, Kurahashi A, et al. Palliative Care Transitions From Acute Care to Community-Based Care—A Systematic Review. Journal of pain and symptom management. 2019;58(4):721–734.e721. doi: 10.1016/j.jpainsymman.2019.06.005.
    1. Øvretveit J. Digital Technologies Supporting Person-Centered Integrated Care – A Perspective. International journal of integrated care. 2017;17(4):6–6. doi: 10.5334/ijic.3051.
    1. Shepperd S, Iliffe S. Hospital at home versus in-patient hospital care. Cochrane database of systematic reviews. 2005;3:CD000356–CD000356.
    1. Cuxart Mèlich A, Estrada CO. Hospital at home: an opportunity for change. Medicina clinica. 2012;138(8):355–360. doi: 10.1016/j.medcli.2011.04.008.
    1. Mogensen CB, Ankersen ES, Lindberg MJ, et al. Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model: ACCESS, an open-labelled randomised clinical trial of effectiveness. Scandinavian journal of trauma, resuscitation and emergency medicine. 2018;26(1):26–26. doi: 10.1186/s13049-018-0492-3.
    1. Rosenthal LJ, Byerly A, Taylor AD, Martinovich Z. Impact and Prevalence of Physical and Verbal Violence Toward Healthcare Workers. Psychosomatics (Washington, DC) 2018;59(6):584–590. doi: 10.1016/j.psym.2018.04.007.
    1. Nowrouzi B, Lightfoot N, Larivière M, et al. Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review. Workplace health & safety. 2015;63(7):308–315. doi: 10.1177/2165079915576931.
    1. Cheng J, Montalto M, Leff B. Hospital at home. Clinics in geriatric medicine. 2009;25(1):79–91. doi: 10.1016/j.cger.2008.10.002.
    1. Centers for Medicare & Medicaid Services. CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge. 2020. . Accessed 15 Feb 2021.
    1. Nielsen M, Buelt L, Patel K, Nichols LM, Fund MM. The patient-centered medical home’s impact on cost and quality. Annual review of evidence. 2015;2014:202014–202015.
    1. Rodríguez Verjan C, Augusto V, Xie X, Buthion V. Economic comparison between Hospital at Home and traditional hospitalization using a simulation-based approach. Journal of enterprise information management. 2013;26(1/2):135–153. doi: 10.1108/17410391311289596.

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