Designing for Patient-Centered Care and Equity in Virtual Hospital-at-Home Models: Quality Improvement Initiative...

The rapid expansion of virtual care during COVID-19 accelerated the development of virtual hospital-at-home models, which deliver hospital-level care in patients' homes through remote monitoring, virtual communication, and in-person support when required. While the virtual hospital-at-home model offers the potential to improve patient-centered care and health equity, rapid implementation often overlooks culturally diverse and underserved populations, including South Asian communities who experience disproportionate chronic disease burden and barriers to accessing culturally relevant services. Strategies are needed to ensure equitable design and adoption of virtual hospital-at-home models.

This study used an experience-based co-design (EBCD) approach to engage patients, caregivers, clinicians, and community organizations in shaping a regional virtual hospital-at-home strategy within the Fraser Health Authority, British Columbia, Canada. The aim was to identify barriers, facilitators, and equity-focused solutions to inform future implementation.

We conducted a five-stage EBCD quality improvement process in the Fraser Health Authority, British Columbia, including (1) forming a multidisciplinary steering committee, (2) reviewing health care provider experiences, (3) interviewing South Asian patients and caregivers, (4) hosting a co-design workshop to develop solutions, and (5) sharing back findings.

Participants identified barriers, including digital literacy, language, and trust in virtual care. The co-designed solutions focused on culturally tailored education, hybrid digital training, caregiver inclusion, and community-driven engagement strategies.

EBCD enabled the development of inclusive and actionable strategies to improve virtual hospital-at-home services. The findings highlight the importance of ongoing community collaboration to ensure equity in virtual care innovation.