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. 2022 Apr;70(4):1060-1069.
doi: 10.1111/jgs.17715. Epub 2022 Feb 24.

A research agenda for hospital at home

Bruce Leff  1 , Linda V DeCherrie  2 , Michael Montalto  3 , David M Levine  4
Affiliations

A research agenda for hospital at home

Bruce Leff et al. J Am Geriatr Soc. 2022 Apr.

Abstract

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.

Keywords: Hospital at home; home-based care; research agenda.

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Conflict of interest statement

Dr. Leff serves as a clinical advisor to Medically Home, Dispatch Health, and the Chartis Group. He serves as a volunteer member of the Humana Multidisciplinary Advisory Board. In the early 2000s, Dr. Leff developed FoF technical assistance tools that were licensed by Johns Hopkins to several entities and, as a result of these license agreements, both the University and its inventors received royalty income. Dr. Leff's arrangements and relationships have been reviewed and approved by the Johns Hopkins University in accordance with its conflicts of interest policy. Drs. Leff and Montalto serve as consultants to the Kenes Group as members of the planning committee of the World Hospital at Home Congress. Drs. DeCherrie, Leff, and Levine lead the HoH Users group, which focuses on HoH technical assistance and is supported by grants from the John A. Hartford Foundation. Dr. Levine has a principal investigator‐initiated study and co‐development agreement with Biofourmis and a principal investigator‐initiated study with IBM, separate from the present work. Dr. DeCherrie was a full‐time employee of the Icahn School of Medicine at Mount Sinai at the time the research was conducted and the manuscript was submitted to JAGS. The Icahn School of Medicine at Mount Sinai has an ownership interest in a joint venture with Contessa Health, a venture that manages acute care services provided to patients in their homes through prospective bundled payment arrangements. Dr. DeCherrie had no personal financial interest in the joint venture. At the time the manuscript revision was submitted, Dr. DeCherrie was a full‐time employee of Medically Home.

Figures

FIGURE 1
FIGURE 1
Survey respondent characteristics
FIGURE 2
FIGURE 2
Hospital at home (HaH) research agenda domains and summary of domain‐specific research focus
See this image and copyright information in PMC

References

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