Background:

Hospital at oHomHHoHome (H@H) (https://www.hospitalathome.org.uk/) offers multi-disciplinary, coordinated acute care in the home, working with patients and carers and interfacing with acute and community-based health and social care services. It is therefore inherently complex, particularly because of the flexibility and adaptability required to accommodate individual needs/circumstances and local contexts, resulting in variations in the service model.

Policy and Practice Partners:

The UK Hospital at Home Society

Co-Funding partners:

N/A

Aims and Objectives:

To produce policy-relevant evidence to inform how H@H could contribute to system recovery- through delivering more acute care for newly or already vulnerable, homebound groups outside of hospital.

Methods:

A realist, rapid systematic review, to develop a programme theory. Interviews with multidisciplinary team members of HaH services, to capture implementation lessons and test the theory. H@H provider survey, to assess the current H@H provision in the UK and examine variations in practice. Qualitative data analysed using ‘framework analysis’ and ‘purposive text analysis’ and quantitative data analysed using descriptive statistics.

Main Results:

The review included 29 articles (2015-2021, from 8 countries). An H@H Programme Theory was extracted consisting of: Organizational Theory, Utilisation Theory, and Impact theory. Eleven UK services were studied by interviewing 1-3 staff members of each service. The theory was found to be feasible in the UK context. Important lessons on implementation issues were captured.

Conclusions:

We now understand better: how H@H works in theory and the essential components for success; how H@H adapts to local needs, e.g. local health issues, existing services, and cultural, socioeconomic, and other diversities; ideally, how patients should interact with H@H to benefit from it; and what are the many benefits of H@H to them. Our study help understand how H@H professionals can ensure patients are safe and feel safe, being looked after in their home, and how other healthcare professionals can utilise this service appropriately. We also learnt lessons on how health services can innovatively create capacity to provide realistic and person-centred care within resource constraints; and how they can upskill their workforce and creatively use both individual-level and team-level skillsets to meet increasingly complex population needs.

Implications for Implementation:

The programme theory can support clinicians to innovate within their services to deliver processes of care that are new for them but are an established part of hospital practice. Policymakers can use our theory to achieve a dual aim of setting national standards of acute medical care in the home and care home setting whilst also permitting appropriate variation by supporting local commissioners and clinicians to develop services that meets the needs of their local population. As a result, patients, their families and carers will benefit through more choice over location of care, including receiving acute medical care at home.