Equity in Innovation: Shaping Hospital at Home Programs for Inclusive Care

Hospital at Home (HaH) programs offer acute-level care within patients' homes, with potential to enhance patient outcomes and experiences and reduce costs. Equity implications of HaH programs are underexplored, and guidance regarding the implementation of equitable HaH programs is limited. To identify potential equity pitfalls in HaH programs, we propose a comprehensive framework, based on the social-ecological model of health and illness. This model consists of five levels: individual, interpersonal, community, organizational/institutional, and state/policy. Key barriers and facilitators for achieving equity are explored at each level, coupled with strategies for improvement based on current literature. At the individual and interpersonal levels, reducing clinician bias and enhancing cultural competence are critical. Next, community engagement is vital for buy-in and participation in HaH programs. Organizationally, institutions must allocate resources to address social drivers of health and avoid exclusion of vulnerable populations while ensuring quality care. State and federal policies, particularly the extension of CMS waivers and clearer regulatory pathways, are necessary to sustain HaH programs and support equity in access. HaH has the potential to bridge equity gaps by addressing structural barriers ingrained in traditional hospital models. A multidisciplinary approach, informed by the social-ecological framework, can guide the implementation of HaH programs that promote inclusivity and equitable care delivery.