What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial

Abstract

ObjectiveHospital at home (HAH) for chronic obstructive pulmonary disease exacerbation selected by low-risk Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score is clinical and cost-effective; DECAF is a prognostic score indicating risk of mortality. Up to 50% of admitted patients are suitable, a much larger proportion than earlier services. Introduction of new models of care is challenging, but may be facilitated by informed engagement with stakeholders. This qualitative study sought to identify facilitators and barriers to implementation of HAH.DesignSemistructured interviews, data were analysed using thematic-construct analysis.SettingInterviews were conducted within patients’ homes and hospitals in North East England.Participants89 participants were interviewees; 44 patients, 15 carers, 15 physicians, 11 specialist nurses and 4 managers.ResultsFacilitators include the following: (1) availability of home comforts and maintaining independence (with positive influences on perceived rate of recovery, sleep quality and convenience for friends, family and carers) and (2) confidence in the continuity of HAH care. Barriers include the following: (1) fear of being alone at home; (2) privacy issues and not wanting visitors and (3) resistance to change. Clinician concerns occasionally delayed return home, principally during the early phase of the trial. Nurses cited higher workload and greater responsibility, but with additional resource and training; overall, they viewed HAH positively. Operational concerns included keeping medical records in a patient’s home and inability to capture activity within current payment systems.ConclusionHAH selected by DECAF was preferred to inpatient care by most patients and their families. Implementation in other hospitals will require education, training and service planning, tailored to overcome the identified barriers.Trial registration numberISRCTN29082260.

Experiences of Patients and Their Caregivers Admitted to a Hospital-at-Home Program in Singapore: a Descriptive Qualitative Study

“…This study explored the perspectives and experiences of patients and their caregivers receiving hospital-at-home care. Similar to studies of HaH programs in the USA and the UK, 16,21 our findings suggested that the patient-centeredness of delivering care at home was associated with perceptions of comfort, convenience, and better quality of care. Key challenges reported in this study were the stress and inconvenience caused to caregivers.…”

An integrated understanding of the multifaceted impact of Hospital at Home: a mixed-methods study to articulate and test a HaH programme theory

“…Patients and carers consistently highlighted the comfort that one felt in the familiar setting of one's own home [18,36,43,46,50]. HaH patients repeatedly mentioned the bene ts of being in the familiar home environment: having all the things one needed and one's own space to "roam" in, knowing where everything was, and being able to do what one routinely did or one felt like doing; and the generally calmer, more relaxing and private environment of home [18,60].…”

“…Cost-saving is derived from shorter length of stay, lower use of clinical testing and consultations, and reduced admissions and readmissions [3,7,13]. Moreover, HaH patients generally experience high levels of satisfaction with the service [19,20,22,23] and appreciate having: comfort in their home environment; ease of admission processes and convenience of care; feelings of safety, reassurance and appreciation; a more seamless care experience with fewer gaps in care transition; greater control over treatment; increased sense of independence; (perceived) quicker recovery; and better physical activity, sleep quality, mood and social contact [7,[16][17][18].…”

Hospital at home: The role for clinical pharmacy in an innovative acute care model in British Columbia

“…In 2019, a qualitative study embedded within a randomized controlled trial assessed the positive drivers and potential barriers to implementation of a HaH program. 6 The study population captured a small ( n = 89) but broad range of stakeholders, including patients, caregivers, doctors, specialist nurses and managers. Semi-structured interview questions were developed within a HaH pilot project and refined using patient feedback.…”