Evaluation of health care providers’ role transition and satisfaction in hospital-at-home for chronic obstructive pulmonary disease exacerbations: a survey study

Abstract

BackgroundHospital-at-home is an accepted alternative for usual hospital treatment for patients with a Chronic Obstructive Pulmonary Disease (COPD) exacerbation. The introduction of hospital-at-home may lead to changes in health care providers’ roles and responsibilities. To date, the impact on providers’ roles is unknown and in addition, little is known about the satisfaction and acceptance of care providers involved in hospital-at-home.MethodsObjective of this survey study was to investigate the role differentiation, role transitions and satisfaction of professional care providers (i.e. pulmonologists, residents, hospital respiratory nurses, generic and specialised community nurses and general practitioners) from 3 hospitals and 2 home care organisations, involved in a community-based hospital-at-home scheme. A combined multiple-choice and open-end questionnaire was administered in study participants.ResultsResponse rate was 10/17 in pulmonologists, 10/23 in residents, 9/12 in hospital respiratory nurses, 15/60 in generic community nurses, 6/10 in specialised community nurses and 25/47 in general practitioners. For between 66% and 100% of respondents the role in early discharge was clear and between 57% and 78% of respondents was satisfied with their role in early discharge. For nurses the role in early discharge was different compared to their role in usual care. 67% of generic community nurses felt they had sufficient knowledge and skills to monitor patients at home, compared to 100% of specialised community nurses. Specialised community nurses felt they should monitor patients. 60% of generic community nurses responded they should monitor patients at home. 78% of pulmonologists, 12% of general practitioners, 55% of hospital respiratory nurses and 48 of community nurses was satisfied with early discharge in general. For coordination of care 29% of community nurses had an unsatisfied response. For continuity of care this was 12% and 10% for hospital respiratory nurses and community nurses, respectively.ConclusionA community-based early assisted discharge for COPD exacerbations is possible and well accepted from the perspective of health care providers’ involved. Satisfaction with the different aspects is good and the transfer of patients in the community while supervised by generic community nurses is possible. Attention should be paid to coordination and continuity of care, especially information transfer between providers.

Patient satisfaction with a hospital-in-the-home service

“…The @home Service Evaluation Working Group developed the patient satisfaction and preference questionnaire based on key elements of the literature review and the tools used by Utens et al (2013) and Jester and Hicks (2003a, b) as their validity had been established. In both studies, the questionnaires were validated following the procedure to develop a questionnaire that would provide answers to their respective research questions.…”

The development of an evaluation framework for a Hospital at Home service

“…The main lessons learned from the review were that a wide range of approaches to evaluation of HH had been used including RCTs, quasi-experimentation comparing HH with in-patient care, retrospective and prospective analyses of HH patient outcomes, a small number of systematic reviews (two), seven studies included some form of economic evaluation and seven of the studies included the perspectives of family carers. Only one study included the perspective of staff working on HH (Utens et al, 2013a) highlighting there is a real dearth of evaluation regarding staff training and education to work on HH and very limited literature regarding staff satisfaction and preference and referrer satisfaction. Many of the experimental designs had relatively small sample sizes and this often was not supported by a justification of the number of participants.…”

“…Patient satisfaction has for some time been viewed as a legitimate goal of health care services, with evidence linking patient dissatisfaction with poorer outcomes mainly due to reduced concordance with advice and treatment regimens and the negative impact on psychological well-being which in turn has a negative impact on physical health, specifically the immune and gastrointestinal systems (Ley, 1990). The working group developed a patient satisfaction and preference questionnaire based on key elements of the literature review and the tools used by Utens et al (2013a) and Jester and Hicks (2003a, b) as their validity with HH patients had been established, but required some modification to meet the specific requirements of this evaluation.…”

Provider Evaluation of a Novel Virtual Hybrid Hospital at Home Model

“…These positive findings are consistent with the experiences reported by providers on the previous models of hospital at home. 11 , 12 …”

“… 10 In previous models of hospital at home where all care given was in-person, evaluations providers were accepting of the model of care, satisfied with the type of care given to patients, and overall were happy with the experience. 11 , 12 But in ACH, the physician and bedside registered nurse care is all virtual in nature, coming from a command center. This leads to the question of whether the provider experience would be positive in this new hospital at home model.…”