Hospital in the Home (HITH) model of care was developed to support the COVID-19 response and the need to deliver care in new ways to ensure secondary care services were free to deliver care to the sickest patients and not be overwhelmed by the COVID-19 patients needing hospital-level care. Intermediate Care Services, led by nursing and allied health stepped up to the challenge and collaborated on the development of the HITH model of care with defined pathways. This provided hospital-level acute health services in the home that was a clinically safe alternative option to inpatient care. The establishment of HITH released bed capacity and resources and therefore prevented the need for expanding hospital inpatient capacity at a time where resources and staff were constrained. Care delivery was achieved by utilising both in-person visits and telehealth. Technology supported the care delivery which allowed patients, whanau (family) and clinicians to be connected.

This study surveys a representative US population about aspects of hospital-at-home care, including acceptability and willingness to perform caregiving tasks.

OBJECTIVE: To examine randomized controlled trials (RCTs) of \"hospital at home\" (HAH) for admission avoidance in adults presenting with acute physical illness to identify the use of vital sign monitoring approaches and evidence for their effectiveness.
METHODS: Systematic review.
METHODS: This review compared strategies for vital sign monitoring in admission avoidance HAH for adults presenting with acute physical illness. Vital sign monitoring can support HAH acute multidisciplinary care by contributing to safety, determining requirement of further assessment, and guiding clinical decisions. There are a wide range of systems currently available, including reliable and automated continuous remote monitoring using wearable devices.
METHODS: Eligible studies were identified through updated database and trial registries searches (March 2, 2016, to February 15, 2023), and existing systematic reviews. Risk of bias was assessed using the Cochrane risk of bias 2 tool. Random effects meta-analyses were performed, and narrative summaries provided stratified by vital sign monitoring approach.
RESULTS: Twenty-one eligible RCTs (3459 participants) were identified. Two approaches to vital sign monitoring were characterized: manual and automated. Reporting was insufficient in the majority of studies for classification. For HAH compared to hospital care, 6-monthly mortality risk ratio (RR) was 0.94 (95% CI 0.78-1.12), 3-monthly readmission to hospital RR 1.02 (0.77-1.35), and length of stay mean difference 1.91 days (0.71-3.12). Readmission to hospital was reduced in the automated monitoring subgroup (RR 0.30 95% CI 0.11-0.86).
CONCLUSIONS: This review highlights gaps in the reporting and evidence base informing remote vital sign monitoring in alternatives to admission for acute illness, despite expanding implementation in clinical practice. Although continuous vital sign monitoring using wearable devices may offer added benefit, its use in existing RCTs is limited. Recommendations for the implementation and evaluation of remote monitoring in future clinical trials are proposed.

BACKGROUND: The global population of adults aged 60 and above surpassed 1 billion in 2020, constituting 13.5% of the global populace. Projections indicate a rise to 2.1 billion by 2050. While Hospital-at-Home (HaH) programs have emerged as a promising alternative to traditional routine hospital care, showing initial benefits in metrics such as lower mortality rates, reduced readmission rates, shorter treatment durations, and improved mental and functional status among older individuals, the robustness and magnitude of these effects relative to conventional hospital settings call for further validation through a comprehensive meta-analysis.
METHODS: A comprehensive literature search was executed during April-June 2023, across PubMed, MEDLINE, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) to include both RCT and non-RCT HaH studies. Statistical analyses were conducted using Review Manager (version 5.4), with Forest plots and I2 statistics employed to detect inter-study heterogeneity. For I2 > 50%, indicative of substantial heterogeneity among the included studies, we employed the random-effects model to account for the variability. For I2 ≤ 50%, we used the fixed effects model. Subgroup analyses were conducted in patients with different health conditions, including cancer, acute medical conditions, chronic medical conditions, orthopedic issues, and medically complex conditions.
RESULTS: Fifteen trials were included in this systematic review, including 7 RCTs and 8 non-RCTs. Outcome measures include mortality, readmission rates, treatment duration, functional status (measured by the Barthel index), and mental status (measured by MMSE). Results suggest that early discharge HaH is linked to decreased mortality, albeit supported by low-certainty evidence across 13 studies. It also shortens the length of treatment, corroborated by seven trials. However, its impact on readmission rates and mental status remains inconclusive, supported by nine and two trials respectively. Functional status, gauged by the Barthel index, indicated potential decline with early discharge HaH, according to four trials. Subgroup analyses reveal similar trends.
CONCLUSIONS: While early discharge HaH shows promise in specific metrics like mortality and treatment duration, its utility is ambiguous in the contexts of readmission, mental status, and functional status, necessitating cautious interpretation of findings.

BACKGROUND: There is no widely accepted care model for managing high-need, high-cost (HNHC) patients. We hypothesized that a Home Heart Hospital (H3), which provides longitudinal, hospital-level at-home care, would improve care quality and reduce costs for HNHC patients with cardiovascular disease (CVD).
OBJECTIVE: To evaluate associations between enrollment in H3, which provides longitudinal, hospital-level at-home care, care quality, and costs for HNHC patients with CVD.
METHODS: This retrospective within-subject cohort study used insurance claims and electronic health records data to evaluate unadjusted and adjusted annualized hospitalization rates, total costs of care, part A costs, and mortality rates before, during, and following H3.
RESULTS: Ninety-four patients were enrolled in H3 between February 2019 and October 2021. Patients\' mean age was 75 years and 50% were female. Common comorbidities included congestive heart failure (50%), atrial fibrillation (37%), coronary artery disease (44%). Relative to pre-enrollment, enrollment in H3 was associated with significant reductions in annualized hospitalization rates (absolute reduction (AR): 2.4 hospitalizations/year, 95% confidence interval [95% CI]: -0.8, -4.0; p < 0.001; total costs of care (AR: -$56 990, 95% CI: -$105 170, -$8810; p < 0.05; and part A costs (AR: -$78 210, 95% CI: -$114 770, -$41 640; p < 0.001). Annualized post-H3 total costs and part A costs were significantly lower than pre-enrollment costs (total costs of care: -$113 510, 95% CI: -$151 340, -$65 320; p < 0.001; part A costs: -$84 480, 95% CI: -$121 040, -$47 920; p < 0.001).
CONCLUSIONS: Longitudinal home-based care models hold promise for improving quality and reducing healthcare spending for HNHC patients with CVD.

The Hospital at Home (HaH) program has experienced accelerated growth in major Canadian provinces, driven in part by technological advancements and evolving patient needs during the COVID-19 pandemic. As an increasing number of hospitals pilot or implement these innovative programs, substantial resources have been allocated to support clinical teams. However, it is crucial to note that the vital roles played by clinical laboratories remain insufficiently acknowledged. This mini review aims to shed light on the diverse functions of clinical laboratories, spanning the preanalytical, analytical, and post-analytical phases within the HaH program context. Additionally, the review will explore recent advancements in clinical testing and the potential benefits of integrating new technologies into the HaH framework. Emphasizing the integral role of clinical laboratories, the discussion will address the current barriers hindering their active involvement, accompanied by proposed solutions. The capacity and efficiency of the HaH program hinge on sustained collaborative efforts from various teams, with clinical laboratories as crucial team players. Recognizing and addressing the specific challenges faced by clinical laboratories is essential for optimizing the overall performance and impact of the HaH initiative.

BACKGROUND: The diffusion of innovation in healthcare is sluggish. Evidence-based care models and interventions take years to reach patients. We believe the healthcare community could deliver innovation to the bedside faster if it followed other sectors by employing an organisational framework for efficiently accomplishing work. Home hospital is an example of sluggish diffusion. This model provides hospital-level care in a patient\'s home instead of in a traditional hospital with equal or better outcomes. Home hospital uptake has steadily grown during the COVID-19 pandemic, yet barriers to launch remain for healthcare organisations, including access to expertise and implementation tools. The Home Hospital Early Adopters Accelerator was created to bring together a network of healthcare organisations to develop tools necessary for programme implementation.
METHODS: The accelerator used the Agile framework known as Scrum to rapidly coordinate work across many different specialised skill sets and blend individuals who had no experience with one another into efficient teams. Its goal was to take 40 weeks to develop 20 \'knowledge products\',or tools critical to the development of a home hospital programme such as workflows, inclusion criteria and protocols. We conducted a mixed-methods evaluation of the accelerator\'s implementation, measuring teams\' productivity and experience.
RESULTS: 18 healthcare organisations participated in the accelerator to produce the expected 20 knowledge products in only 32 working weeks, a 20% reduction in time. Nearly all (97.4%) participants agreed or strongly agreed the Scrum teams worked well together, and 96.8% felt the teams produced a high-quality product. Participants consistently remarked that the Scrum team developed products much faster than their respective organisational teams. The accelerator was not a panacea: it was challenging for some participants to become familiar with the Scrum framework and some participants struggled with balancing participation in the Accelerator with their job duties.
CONCLUSIONS: Implementation of an Agile-based accelerator that joined disparate healthcare organisations into teams equipped to create knowledge products for home hospitals proved both efficient and effective. We demonstrate that implementing an organisational framework to accomplish work is a valuable approach that may be transformative for the sector.

The care model Hospital@Home offers hospital-level treatment at home, aiming to alleviate hospital strain and enhance patient comfort. Despite its potential, integrating digital health solutions into this care model still remains limited. This paper proposes a concept for integrating laboratory testing at the Point of Care (POC) into Hospital@Home models to improve efficiency and interoperability.
METHODS: Using the HL7 FHIR standard and cloud infrastructure, we developed a concept for direct transmission of laboratory data collected at POC. Requirements were derived from literature and discussions with a POC testing device producer. An architecture for data exchange was developed based on these requirements.
RESULTS: Our concept enables access to laboratory data collected at POC, facilitating efficient data transfer and enhancing interoperability. A hypothetical scenario demonstrates the concept\'s feasibility and benefits, showcasing improved patient care and streamlined processes in Hospital@Home settings.
CONCLUSIONS: Integration of POC data into Hospital@Home models using the HL7 FHIR standard and cloud infrastructure offers potential to enhance patient care and streamline processes. Addressing challenges such as data security and privacy is crucial for its successful implementation into practice.

Hospital@home is a healthcare approach, where patients receive active treatment from health professionals in their own home for conditions that would normally necessitate a hospital stay.
OBJECTIVE: To develop a framework of relevant features for describing hospital@home care models.
METHODS: The framework was developed based on a literature review and thematic analysis. We considered 42 papers describing hospital@home care approaches. Extracted features were grouped and aggregated in a framework.
RESULTS: The framework consists of nine dimensions: Persons involved, target patient population, service delivery, intended outcome, first point of contact, technology involved, quality, and data collection. The framework provides a comprehensive list of required roles, technologies and service types.
CONCLUSIONS: The framework can act as a guide for researchers to develop new technologies or interventions to improve hospital@home, particularly in areas such as tele-health, wearable technology, and patient self-management tools. Healthcare providers can use the framework as a guide or blueprint for building or expanding upon their hospital@home services.

OBJECTIVE: Hospital at home (HaH) program development, spurred by hospital congestion during the COVID-19 pandemic, is moving from a novel idea to a standard of inpatient practice. Understanding pharmacy\'s clinical role in the HaH patient care team is exceedingly important as programs across the country continue to develop, implement, and expand. The purpose of this study is to describe how clinical pharmacy services are currently provided for home hospital patients and to explain the vital role of pharmacists within the HaH care team.
METHODS: A descriptive study was designed to evaluate pharmacy services provided for home hospital patients from January 1, 2023, to February 28, 2023. Prior to the study period, a focused group of pharmacists routinely active in HaH patient care met to define a standard process for documenting pharmacy services using an electronic documentation system (i-Vent) within the EHR. During the study period, a total of 221 patients were admitted to home hospital at either site representing 3,258 inpatient medication orders with 2,997 medication administrations. Pharmacists signed 903 progress notes and documented 561 interventions across all types. The top 3 pharmacy intervention types were drug administration change (37%), medication reconciliation (29%), and antimicrobial stewardship (15%). Each of the top 3 types were further evaluated by subtype.
CONCLUSIONS: Documented pharmacy services encompassed a variety of intervention types. The overwhelming majority of patients admitted to the program received pharmacy consultative services, demonstrating how pivotal pharmacists are to the operational success of these programs and clinical care of HaH patients. More research is needed to expose pharmacy potential and facilitate growth for pharmacists practicing in HaH programs.