Starting Up a Hospital at Home Program

Facilitators and Barriers to Implementation

Abraham A. Brody, Alicia Arbaje, Linda V. DeCherrie, Alex D. Federman, Bruce A Leff, Albert L. Siu

Research output: Contribution to journalArticle

Abstract

Background: Hospital at home (HaH) is a model of care that provides acute-level services in the home. HaH has been shown to improve quality and patient satisfaction, and reduce iatrogenesis and costs. Uptake of HaH in the United States has been limited, and little research exists on how to implement it successfully. Objectives: This study examined facilitators and barriers to implementation of an HaH program. Design: A HaH program that included a 30-day transitional care bundle following the acute stay was implemented through a Centers for Medicare & Medicaid Services Innovations Award. Informants completed a priming table describing initial implementation components, their barriers, and facilitators. These were followed up with semistructured focus groups and individual interviews that were transcribed and independently coded using thematic analysis by two independent investigators. Setting: Large urban academic health system. Participants: Clinical and administrative personnel from Mount Sinai, the Visiting Nurse Service of New York, and executive leaders at partner organizations (laboratory, pharmacy, radiology, and transportation). Results: To facilitate successful development and implementation of a high-quality HaH program, a number of barriers needed to be overcome through significant teamwork and communication internally with policymakers and external partners. Areas of paramount importance include facilitating work-arounds to regulatory barriers and health system policies; altering an electronic health record that was not designed for HaH; developing the necessary payment and billing mechanisms; and building effective and collaborative partnerships and communication with outside vendors. Conclusion: Development of HaH programs in the United States are feasible but require strategic planning and development of strong, tightly coordinated partnerships.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StatePublished - Jan 1 2019

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Patient Care Bundles
Communication
Hospital Design and Construction
Urban Health
Community Health Nurses
Electronic Health Records
Medicaid
Medicare
Health Policy
Focus Groups
Administrative Personnel
Patient Satisfaction
Radiology
Research Personnel
Organizations
Interviews
Costs and Cost Analysis
Research
Strategic Planning
Transitional Care

Keywords

  • home care
  • home hospitalization
  • home-based care
  • hospital at home
  • implementation science

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Starting Up a Hospital at Home Program : Facilitators and Barriers to Implementation. / Brody, Abraham A.; Arbaje, Alicia; DeCherrie, Linda V.; Federman, Alex D.; Leff, Bruce A; Siu, Albert L.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

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