Contextual Interaction with Patient and Caregiver Factors for Hospital-at-Home Program Engagement.

BackgroundHospital at Home (HaH) is an alternative model of care, where patients who would otherwise be hospitalized are transferred home with hospital care to be carried out in the home environment. Caregivers are central to HaH programs as many patient care tasks shift from hospital personnel to in-home informal caregivers. ObjectiveTo describe the experiences of patients and caregivers, identify factors affecting care delivery, and identify potential patient and caregiver factors serving as barriers and facilitators to engage in a HaH program. Study Setting and DesignThe study was conducted in a large, academic center in the Southeastern US. Data Sources and Analytic SampleThis qualitative study enrolled a purposive sample of English-speaking patients who received treatment at home and with caregivers of patients who had received HaH services. The Qualitative Research Core conducted 30 to 60 minutes interviews using semi-structured interview guides for patients and caregivers. A total of twenty-three interviews were conducted. Principal FindingsA conceptual framework was developed indicating an interaction between patient/caregiver-level factors (e.g., program attitudes and beliefs) with factors in the broader HaH program context (e.g., provider experience). Modifying factors (e.g., past experiences with hospitalization) affected patient and caregivers willingness to engage in the HaH program. ConclusionsPatients and caregivers are willing to engage in HaH but their willingness is affected by factors in the broader caregiving context and person-level factors. Their experience with previous hospitalizations and the COVID-19 pandemic affected their willingness to engage.