Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis

Abstract

Background Hospital-at-home (HaH) provides acute healthcare in patients’ homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care. Methodology Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso’s guidelines. Results Sixteen articles met the inclusion criteria. The overarching synthesized theme was “the intricacies of developing HaH,” and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development. Conclusion Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07065-0.

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“…(38) Facilitators at the organisational level related to supportive operational, regulatory and legal frameworks, co-ordination and integration of care, including with post-discharge care; and staff with strong clinical and communication skills. (15, 34, 38)…”

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“… 18 , 19 Additionally, HaH patients did not perceive a continuity gap unlike many patients who transition from the inpatient hospital setting to home. 20 …”

“…Studies on current HaH have shown that family members and home caregivers play an important role in the successful outcome of HaH. 20 , 29 , 30 For patients of families with adverse SDOH, this might be particularly true. 20 , 30 A discussion with the patient’s family or others assisting in care is necessary to uncover concerns regarding their roles, skills, financial status, and general ability to provide valuable home assistance.…”

“… 20 , 29 , 30 For patients of families with adverse SDOH, this might be particularly true. 20 , 30 A discussion with the patient’s family or others assisting in care is necessary to uncover concerns regarding their roles, skills, financial status, and general ability to provide valuable home assistance. 20 This is the case when those helping at home felt a sense of responsibility for monitoring, care, and safety of the patient—a role they may not be prepared for emotionally, logistically, or economically.…”

“… 20 , 30 A discussion with the patient’s family or others assisting in care is necessary to uncover concerns regarding their roles, skills, financial status, and general ability to provide valuable home assistance. 20 This is the case when those helping at home felt a sense of responsibility for monitoring, care, and safety of the patient—a role they may not be prepared for emotionally, logistically, or economically. While HaH may be deemed more comfortable, desirable, and preferred for the patient, it may trade this for increased stress, responsibility, and hardship for family members with limited resources.…”