Virtual Health Care in Hospital-at-Home Models for Patients With Acute Infections: A Scoping Review

Abstract

Given the imbalance between high care demand and strained hospital capacity, hospital-at-home (HaH) models offer a potential solution by providing hospital-level care in patients' homes. This scoping review maps the literature on hospital-led virtual health care within HaH models for acute infections, focusing on intervention characteristics and evaluation designs. Following Johanna Briggs Institute guidelines and PRISMA-ScR, we included studies on virtual and hybrid HaH models using telemedicine for remote monitoring and interventions. The literature searches were performed from October 3, 2022 to October 22, 2022, and updated on July 11, 2024 and identified 15,062 potentially relevant records. From these, 79 studies met the inclusion criteria, highlighting the diversity of HaH models and their evaluations. Hybrid models provided broader treatment options, but many studies lacked detailed intervention descriptions, complicating implementation and meta-analyses. Most studies evaluated patient outcomes, with limited attention to health care staff and relatives. Nearly 45,000 participants were assessed, but only 254 participated in randomized controlled trials, indicating a need for more high-level evidence. Relevant gaps remain, including model heterogeneity and inconsistent reporting.

Figure 1

PRISMA—flow diagram of study identification, screening, and inclusion. Flow diagram illustrating the selection process for studies included in this scoping review of hospital-led virtual and hybrid hospital-at-home models for patients with acute infections.

Figure 2

Parallel set plot. This parallel set plot visualizes the relationships among participant types (patients, personnel, and relatives), study designs (quantitative, qualitative, and multi-methods), use of randomized controlled trials (RCT vs non-RCT), and model types (hybrid vs virtual) across the 79 included studies. The width of each flow represents the number of participants, highlighting that most studies focused on patients, employed quantitative methods, and were non-randomized. Hybrid models were more commonly used than virtual models.

Figure 3

Treemap of virtual versus hybrid HaH model components. This treemap illustrates the distribution and relative frequency of key components across virtual and hybrid HaH models for patients with acute infections. Components are grouped into 5 categories: mode of communication (light blue), monitoring (dark blue), tests (light brown), treatment (dark brown), and workforce (pink). The size of each rectangle reflects the prevalence of that component within the respective model type. The visualization highlights the structural differences and resource allocation patterns between virtual and hybrid care models.