Abraham A Brody1,2,3, Alicia I Arbaje4,5,6, Linda V DeCherrie2,7, Alex D Federman7, Bruce Leff4,8,9, Albert L Siu2,3. 1. Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York. 2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Geriatric Research Education and Clinical Center, James J Peters Bronx VAMC, Bronx, New York. 4. Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. 5. Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland. 6. Department of Clinical Investigation, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 7. Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 8. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 9. Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland.
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. J Am Geriatr Soc 67:588-595, 2019.
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. J Am Geriatr Soc 67:588-595, 2019.
Authors: Kushal T Kadakia; Celynne A Balatbat; Albert L Siu; I Glenn Cohen; Consuelo H Wilkins; Victor J Dzau; Anaeze C Offodile 2nd Journal: Milbank Q Date: 2022-09-23 Impact factor: 6.237
Authors: Amal Fakha; Lindsay Groenvynck; Bram de Boer; Theo van Achterberg; Jan Hamers; Hilde Verbeek Journal: Implement Sci Date: 2021-02-26 Impact factor: 7.327
Authors: Surya Singh; Alastair Gray; Sasha Shepperd; David J Stott; Graham Ellis; Anthony Hemsley; Pradeep Khanna; Scott Ramsay; Rebekah Schiff; Apostolos Tsiachristas; Angela Wilkinson; John Young Journal: Age Ageing Date: 2022-01-06 Impact factor: 10.668