Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation

Area of Science:

• Healthcare delivery models
• Health services research
• Geriatric medicine

Background:

• Hospital at Home (HaH) offers acute care services in patients' homes, improving quality and satisfaction while reducing costs.
• Despite benefits, HaH adoption in the US faces limited uptake and research on successful implementation strategies.

Purpose of the Study:

• To identify facilitators and barriers in implementing a Hospital at Home (HaH) program.
• To inform successful strategies for broader HaH program development in the United States.

Main Methods:

• A HaH program with a 30-day transitional care bundle was implemented via a CMS Innovations Award.
• Thematic analysis of semistructured focus groups and interviews with clinical, administrative, and executive personnel.
• Priming tables were used to document initial implementation components, barriers, and facilitators.

Main Results:

• Overcoming regulatory and health system policy barriers is crucial for HaH implementation.
• Adapting electronic health records and developing payment/billing mechanisms are key challenges.
• Establishing effective partnerships and communication with internal and external stakeholders, including vendors, is paramount.

Conclusions:

• Developing Hospital at Home programs in the US is feasible.
• Successful HaH implementation necessitates strategic planning and robust, coordinated partnerships.
• Addressing systemic and logistical challenges is vital for widespread HaH adoption.