Identifying recruitment and enrollment barriers in home-based acute care: findings from a regional pilot program in...

BACKGROUND: Hospital-at-home (HaH) programs provide acute medical care in home settings as an alternative to traditional inpatient hospitalization. In July 2024, the National Health Insurance Administration of Taiwan launched an HaH pilot program. This program focuses on older adults with frailty and operates through 2 referral models: emergency passed admission (EPA) and direct home admission (DHA). METHODS: This retrospective observational study was conducted in the Xinwu-Tai region of New Taipei City, Taiwan, from September 2024 to June 2025. Patient screening records were reviewed to determine the reasons for enrollment failure and identify the outcomes of those admitted. Key variables included diagnosis, referral model, functional status, clinical stability, treatment duration, and readmission. RESULTS: Of 1462 emergency department (ED) person-days screened, only 180 (12.3%) were eligible for the HaH program, with 6 (0.4%) enrolled through the EPA model. Among 1282 ineligible ED person-days, 50.6% were excluded for insufficient functional impairment (Barthel’s index > 60) and 49.4% were excluded for unstable clinical conditions. Another 5 ventilator-dependent patients were enrolled through the DHA model, yielding a 71.4% admission rate and a total of 11 HaH cases. A total of 10 patients completed home treatment without complications; only one required ED revisitation within 14 days. CONCLUSIONS: Enrollment in the HaH program in Taiwan is limited by strict eligibility criteria, particularly through the EPA model. However, the favorable outcomes observed among the admitted patients support the model’s safety, feasibility, and cost-effectiveness. Expanding referral models and refining inclusion criteria may boost participation and enhance the program’s impact.