Why U.S. Patients Declined Hospital-at-Home during the COVID-19 Public Health Emergency: An Exploratory Mixed Methods...

Area of Science:

• Healthcare delivery innovation
• Patient engagement strategies
• Public health emergency response

Background:

• The COVID-19 Public Health Emergency accelerated the adoption of hospital-at-home (H@H) care models.
• Understanding patient refusal is crucial for optimizing H@H program accessibility and effectiveness.

Purpose of the Study:

• To investigate patient refusal reasons for hospital-at-home (H@H) care during the COVID-19 Public Health Emergency.
• To identify quantitative associations between patient characteristics and H@H participation.
• To explore qualitative themes influencing H@H refusal.

Main Methods:

• A convergent-parallel study design was employed at two Mayo Clinic sites (August 2021–March 2022).
• Quantitative analysis examined associations between H@H participation and baseline patient data.
• Qualitative interviews with patients who refused H@H were conducted (n=13).

Main Results:

• H@H patients were more likely to have a patient portal, indicating telehealth familiarity (P=.014).
• Refusers were more likely from the Northwest Wisconsin region (P<.001) and had higher Epic Deterioration Index scores (P=.004).
• Qualitative themes included lack of clarity about H@H and perceived domestic challenges.

Conclusions:

• Patient refusal of H@H care is linked to limited understanding and domestic barriers.
• Enhanced patient and staff education on H@H dynamics is essential.
• Inclusive strategies are needed to address domestic and diagnostic challenges, improving H@H access.