Distilling lessons from home hospital implementation: a narrative scoping review

Area of Science:

• Healthcare Management
• Health Services Research
• Geriatric Medicine

Background:

• Hospital at Home (HaH) is a promising healthcare model with demonstrated benefits including higher quality of care, reduced readmissions, shorter lengths of stay, lower costs, and increased patient satisfaction.
• Existing reviews predominantly focus on quantitative clinical outcomes, with a gap in collating qualitative insights and implementation lessons from HaH initiatives.

Purpose of the Study:

• To systematically review and synthesize qualitative insights and lessons learned from past Hospital at Home (HaH) implementations.
• To identify critical success factors for HaH adoption and integration into healthcare systems.

Main Methods:

• A systematic literature search was conducted across four databases, including 17 papers detailing the provision of acute and/or subacute care in patients' homes.
• Extracted data included review characteristics, relevant outcomes, stakeholder attitudes, and factors contributing to the success of HaH implementation.

Main Results:

• Patient and caregiver factors influencing HaH success include home setup, preferences for care/death settings, and caregiver support.
• Healthcare professional and intervention factors encompass multidisciplinary teams, emergency care accessibility, provider/patient training, adequate staffing, clear eligibility/referral criteria, pathway awareness, communication, and medication management.

Conclusions:

• Hospital at Home (HaH) represents a viable alternative care model with identified success factors readily available in current healthcare infrastructures.
• Singapore's existing frameworks for data sharing, strong community networks, and emphasis on multidisciplinary teams position it favorably for adopting HaH.