Predictors and Reasons Why Patients Decline to Participate in Home Hospital: a Mixed Methods Analysis of a Randomized Controlled Trial

Levine, David M.; Paz, Mary; Burke, Kimberly; Schnipper, Jeffrey L.

doi:10.1007/s11606-021-06833-2

Cited by 25 publications

(25 citation statements)

References 15 publications

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“… 8 , 9 , 13 , 15 , 29 , 30 , 31 , 32 Fewer studies have examined why patients accept or decline HaH care. 33 , 34 A HaH‐specific care experience conceptual framework should be developed, which could inform development of a HaH‐specific care experience measurement tool. The characteristics of patients and caregivers associated with HaH care experience and whether and how experience varies with the specific type HaH services provided should be clarified.…”

Section: Resultsmentioning

confidence: 99%

A research agenda for hospital at home

Leff

DeCherrie

Montalto

et al. 2022

J American Geriatrics Society

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Background: Hospital at home (HaH) provides hospital-level care at home as a substitute for traditional hospital care. Interest in HaH is increasing markedly. While multiple studies of HaH have demonstrated that HaH provides safe, high-quality, cost-effective care, there remain many unanswered research questions. The objective of this study is to develop a research agenda to guide future HaH-related research. Methods: Survey of attendees of first World HaH Congress 2019 for input on research for the future HaH development. Selection and ranking of important topic areas for future HaH-related research. Development of research domains and research questions and issues using grounded theory approach, supplemented by focused literature reviews. Results: 240 conference attendees responded to the survey (response rate, 55.3%). The majority were from Europe (64%) and North America (11%) and were HaH program leaders (29%), HaH physicians (27%), and researchers (13%). Nine research domains for future HaH research were identified: 1) definition of the HaH model of care; 2) the HaH clinical model; 3) measurement and outcomes of HaH; 4) patient and caregiver experience with HaH; 5) education and training of HaH clinicians; 6) technology and telehealth for HaH; 7) regulatory and payment issues in HaH; 8) implementation and scaling of HaH; and 9) ethical issues in HaH. Key research issues and questions were identified for each domain. Conclusions: While highly evidence-based, unanswered research questions regarding HaH remain, focusing research efforts on the domains identified in this study will serve to improve HaH for all key HaH stakeholders.

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Section: Resultsmentioning

confidence: 99%

A research agenda for hospital at home

Leff

DeCherrie

Montalto

et al. 2022

J American Geriatrics Society

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“…This left the research assistant to maneuver through the complex care coordination system. From prior work on acute care at home, we feel that many of the declines involving the patient, family, and care coordinator could have been ameliorated with a greater physician presence (D. M. Levine et al, 2021). Learnings from recruitment challenges will change how we recruit for a follow-on RCT.…”

Section: Discussionmentioning

confidence: 99%

Skilled Nursing Facility Care at Home for Adults Discharged From the Hospital: A Pilot Randomized Controlled Trial

et al. 2022

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Objectives The ability to deliver SNF-level care at home is unclear. We sought to demonstrate the feasibility of rehabilitation at home (RAH) via a pilot randomized controlled trial. Methods Daily care from a home health aide, certified nursing assistant, nurse, and physician. Core technologies included remote PT, automated medication dispensing, and continuous monitoring. Primary outcome: episode cost. Results We randomized 10 patients. Home patients’ episode cost a median $8404 (IQR, $2697) versus $9215 (IQR, $5702). LOS for both was 14 days. Home patients’ ADLs improved between admission and 30-days post-discharge by median 4 (IQR, 5) versus 1 (IQR, 2). Home patients’ median Picker patient experience score was 12/14 (IQR, 2) versus 7/14 (IQR, 3). Discussion A RAH pilot compared favorably to traditional SNF, with trends toward lower cost, greater functional status improvement, and better patient experience. This delivery innovation could reimagine how we deliver post-acute care but requires replication. Clinicaltrials.gov registration NCT04048590.

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“…15,33,[38][39][40][41] However, the exact responsibilities of caregivers under HaH remain inconsistently defined across programs, and some patients report perceiving additional caregiving burdens and costs (e.g., for utilities) with HaH. 34,42,43 Therefore, efforts to convert the home into a site-of-care should be accompanied by policies that minimize the risk of task-shifting, additional expenses, and disruptions to daily life. Examples of program-level interventions are routinely using validated assessment tools to determine caregivers' burden, providing financial assistance to caregivers, implementing temporary relief from day-to-day responsibilities (i.e., respite for caregivers), and offering HaH-related training.…”

Section: Caregiver Perspectivementioning

confidence: 99%

“…For example, some patients who opted against participating expressed concerns about the sufficiency, safety, or convenience of alternatives to facility‐based care. Others cited social factors like concern for the caregiver's burden and the amenability of their home's built environment to care delivery (e.g., space constraints) as reasons for declining to enroll in HaH 33,34 . Although demographic factors have generally not affected enrollment in randomized controlled trials for HaH, one retrospective analysis of HaH cohorts in Australia did identify differential participation rates according to socioeconomic status and non‐English speakers 35 .…”

Section: Sector‐specific Program and Policy Considerationsmentioning

confidence: 99%

Hospital‐at‐Home: Multistakeholder Considerations for Program Dissemination and Scale

Kadakia

Balatbat²,

Siu

et al. 2022

Milbank Quarterly

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Hospital-at-Home (HaH) is a home-based alternative for acute care that has expanded significantly under COVID-19 regulatory flexibilities.r The post-pandemic policy agenda for HaH will require consideration of multistakeholder perspectives, including patient, caregiver, provider, clinical operations, technology, equity, legal, quality, and payer.r Key policy challenges include reaching a consensus on program standards, clarifying caregivers' issues, creating sustainable reimbursement mechanisms, and mitigating potential equity concerns.Funding/Support: The authors of this perspective had no sources of support.

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Predictors and Reasons Why Patients Decline to Participate in Home Hospital: a Mixed Methods Analysis of a Randomized Controlled Trial

Cited by 25 publications

References 15 publications

A research agenda for hospital at home

A research agenda for hospital at home

Skilled Nursing Facility Care at Home for Adults Discharged From the Hospital: A Pilot Randomized Controlled Trial

Hospital‐at‐Home: Multistakeholder Considerations for Program Dissemination and Scale

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