Effectiveness of a Multifaceted Implementation Strategy to Increase Equitable Hospital at Home Utilization: An...

Area of Science:

• Healthcare Management
• Health Services Research
• Implementation Science

Background:

• Hospital-at-Home (HaH) programs saw rapid growth during the COVID-19 pandemic and following the CMS Acute Hospital Care at Home (AHCaH) waiver.
• Limited evidence exists on effective strategies for equitable HaH utilization expansion.

Purpose of the Study:

• To evaluate the impact of a multifaceted implementation strategy on Hospital-at-Home (HaH) utilization over time.
• To assess changes in HaH capacity, provider referrals, and patient demographics.

Main Methods:

• A before-and-after evaluation using electronic health record (EHR) data and interrupted time series analysis.
• Qualitative interviews with 12 HaH patients and 10 referring clinicians to identify barriers and facilitators.
• Comparison of a discrete implementation strategy (educational outreach) with a multifaceted strategy (outreach, nurse navigators, executive involvement, audit/feedback).

Main Results:

• The multifaceted strategy led to significant week-to-week increases in HaH capacity utilization (OR 1.02) and referring providers (mean ratio 1.05).
• HaH utilization saw the largest increase among rural residents, rising from 11% to 34%.
• Key barriers included information gaps and referral challenges, while patient-centeredness was a major facilitator.

Conclusions:

• A multifaceted implementation strategy effectively increased HaH capacity, provider adoption, and patient diversity.
• Health systems can leverage similar contextually relevant, multicomponent strategies to equitably scale HaH programs.
• Patient-centeredness emerged as a critical facilitator for HaH adoption.