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The purpose of this study is to examine the implementation, intervention effectiveness, and dissemination of a digital acute care delivery model for improving selected health outcomes in the Hospital at Home population.
The investigators will conduct a mixed-methods quasi-experimental research study that will explore the effectiveness of the Hospital at home programs using qualitative interviews and quantitative data as a means to also conduct a process evaluation related to the implementation and efficacy of Hospital at Home programs. The purpose of this pragmatic study is to inform scalability beyond the initial site for implementation within a large healthcare system with a diverse patient population located in various communities, including rural and urban locations.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hospital at Home Care | The population for this study includes adult patients who are acutely ill and presenting to the emergency room, and are discharged to their home for hospital-level care in the home setting. The patients in this cohort may also include those who are discharged from the hospital early, but receive hospital-level care in the home setting. |
| |
| Traditional Hospital Care | The population for this study includes adult patients who are acutely ill and presenting to the emergency room who elect not to be discharged, choose to be cared for in the hospital setting. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Digital Care Solution as supportive personalized care | Other | Patients will need to meet screening and inclusion criteria at time of enrollment. As a pragmatic study, researchers will not determine criteria or management of care aspects for patients. |
| Measure | Description | Time Frame |
|---|---|---|
| Composite of all-cause mortality for patients admitted to digital hospital | Total number of deaths over total number of patients admitted to the digital hospital. | Up to 30 days, (date of death from any cause, whichever came first, assessed up to 30 days) |
| 30-day readmission rate | Number of 30-day readmissions as defined by Organization using preset criteria | Up to 30 days (date of readmission from any cause, whichever came first, assessed up to 30 days) |
| Patient Satisfaction at discharge | 1-item measure: I would recommend this [insert program name] to others, assessed at discharge name] to others. | up to 1 week |
| Patient Perception of Digital Care at discharge | Results of Digital Care - Likert Scale (very satisfied to very dissatisfied) | up to 1 week |
| Measure | Description | Time Frame |
|---|---|---|
| Escalations (for management and treatment of early decompensation) | percentage of patients escalated over total hospital digital encounters | up to 2 weeks |
| Unplanned readmission within 30-days of discharge |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants with discharge disposition at time of discharge as one other than home | Exploratory - discharge disposition other than patient's home | assessed up to 8 weeks |
| Qualitative interviews |
Inclusion Criteria:
Patient caregiver inclusion criteria: (not required for patient participation):
Clinician or stakeholder inclusion criteria:
Exclusion Criteria:
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The study population will consist of individuals who are receiving care in the hospital at home program and those who are hospitalized but choose to receive hospital care in the home setting after a short period in the hospital. All those enrolled in the Hospital at Home Program will be strategically identified and used as the population for the quantitative and qualitative portions of the study.
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| Name | Affiliation | Role |
|---|---|---|
| Colleen Klein, PhD, APRN | OSF HealthCare | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| OSF HealthCare | Peoria | Illinois | 61602 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34100939 | Background | Arsenault-Lapierre G, Henein M, Gaid D, Le Berre M, Gore G, Vedel I. Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department: A Systematic Review and Meta-analysis. JAMA Netw Open. 2021 Jun 1;4(6):e2111568. doi: 10.1001/jamanetworkopen.2021.11568. | |
| 30735244 | Background |
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|
| Traditional Hospital Level Care | Other | Patients will be cared for in the inpatient setting for management of diseases that meet screening and inclusion criteria at time of enrollment for hospital at home. As a pragmatic study, researchers will not determine criteria or management of care aspects for patients. |
|
Number of 30-day readmissions over total number of discharges
| up to 30 days |
| Length of Stay | Day of admission to day of discharge, assessed up to 2 months | assessed up to 2 weeks |
| Number of participants with Hospital Acquired Infections | Number of hospital acquired infections reported (CAUTI, CLABSI, etc.) | assessed up to 1 week |
Interviews with patients, caregivers, and hospital and digital health clinicians, workers, ancillary services
| through study completion, an average of 2 years |
| Number of readmissions between discharge and during next 6 months. | Exploratory | Up to 6 months (Re-admission from any cause, assessed up to 6 months) |
| Number of Emergency Department visits after discharge for any cause | Exploratory | assessed up to 6 months |
| Number of visits in home by provider, clinician, and worker type | Exploratory | assessed up to 2 months |
| EuroQol-5D-5L | 5 items self-reported and visual analogue scale, 0-100, where 100 is the best imaginable health today | up to 2 months, assessed twice in this period |
| Program Implementation and Evaluation Measure | 15-item measure to assess health care professionals' perceptions of digital care, measured using a Likert scale of 1 to 5, with 1= Not at all, 2=Slightly, 3=Moderately, 4=Very Much, and 5= Entirely. Includes three open-ended questions | at baseline and 1-year following implementation |
| Montgomery caregiver burden inventory measure | 11-items to assess objective, relationship, and stress for caregivers. A 5-point response set ranging from 1 (not at all) to 5 (a great deal) | at approximately 48 hours following admission and at 31-days post-discharge |
| Clinical Sustainability Assessment Tool | Exploratory - measures organizational and contextual factors for sustainability of a project or initiative. Uses a 7-point Likert scale where 1= to little or no extent to 7=to a great extent. Also includes response option of N/A - not able to answer. | at baseline and 1-year following implementation |
| Brody AA, Arbaje AI, DeCherrie LV, Federman AD, Leff B, Siu AL. Starting Up a Hospital at Home Program: Facilitators and Barriers to Implementation. J Am Geriatr Soc. 2019 Mar;67(3):588-595. doi: 10.1111/jgs.15782. Epub 2019 Feb 8. |
| 34363185 | Background | Chua CMS, Ko SQ, Lai YF, Lim YW, Shorey S. Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis. J Gen Intern Med. 2022 Feb;37(3):637-650. doi: 10.1007/s11606-021-07065-0. Epub 2021 Aug 6. |
| 34608377 | Background | Cooling M, Klein CJ, Pierce LM, Delinski N, Lotz A, Vozenilek JA. Access to Care: End-to-End Digital Response for COVID-19 Care Delivery. J Nurse Pract. 2022 Feb;18(2):232-235. doi: 10.1016/j.nurpra.2021.09.011. Epub 2021 Sep 25. |
| 30948606 | Background | Dismore LL, Echevarria C, van Wersch A, Gibson J, Bourke S. What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial. BMJ Open. 2019 Apr 4;9(4):e026609. doi: 10.1136/bmjopen-2018-026609. |
| 29946693 | Background | Federman AD, Soones T, DeCherrie LV, Leff B, Siu AL. Association of a Bundled Hospital-at-Home and 30-Day Postacute Transitional Care Program With Clinical Outcomes and Patient Experiences. JAMA Intern Med. 2018 Aug 1;178(8):1033-1040. doi: 10.1001/jamainternmed.2018.2562. |
| 16330791 | Background | Leff B, Burton L, Mader SL, Naughton B, Burl J, Inouye SK, Greenough WB 3rd, Guido S, Langston C, Frick KD, Steinwachs D, Burton JR. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Ann Intern Med. 2005 Dec 6;143(11):798-808. doi: 10.7326/0003-4819-143-11-200512060-00008. |
| 21135026 | Background | Savundranayagam MY, Montgomery RJ, Kosloski K. A dimensional analysis of caregiver burden among spouses and adult children. Gerontologist. 2011 Jun;51(3):321-31. doi: 10.1093/geront/gnq102. Epub 2010 Dec 6. |
| 32478025 | Background | Shelton RC, Chambers DA, Glasgow RE. An Extension of RE-AIM to Enhance Sustainability: Addressing Dynamic Context and Promoting Health Equity Over Time. Front Public Health. 2020 May 12;8:134. doi: 10.3389/fpubh.2020.00134. eCollection 2020. |
| 35710450 | Background | Yao X, Paulson M, Maniaci MJ, Dunn AN, Nelson CR, Behnken EM, Hart MS, Sangaralingham LR, Inselman SA, Lampman MA, Dunlay SM, Dowdy SC, Habermann EB. Effect of hospital-at-home vs. traditional brick-and-mortar hospital care in acutely ill adults: study protocol for a pragmatic randomized controlled trial. Trials. 2022 Jun 16;23(1):503. doi: 10.1186/s13063-022-06430-6. |
| 40464036 | Derived | Dalstrom MD, Klein CJ, Rothrock-Magana M, Cooling M. Patient-Centered Care: A Qualitative Analysis of Patient and Caregiver Experiences in a Hospital at Home Program. J Patient Exp. 2025 Jun 2;12:23743735251347706. doi: 10.1177/23743735251347706. eCollection 2025. |
| ID | Term |
|---|---|
| D004194 | Disease |
| D007239 | Infections |
| D006333 | Heart Failure |
| D014570 | Urologic Diseases |
| D003920 | Diabetes Mellitus |
| D006973 | Hypertension |
| D005334 | Fever |
| D001991 | Bronchitis |
| D001249 | Asthma |
| D029424 | Pulmonary Disease, Chronic Obstructive |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D014652 | Vascular Diseases |
| D001832 | Body Temperature Changes |
| D012816 | Signs and Symptoms |
| D012141 | Respiratory Tract Infections |
| D001982 | Bronchial Diseases |
| D012140 | Respiratory Tract Diseases |
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012130 | Respiratory Hypersensitivity |
| D006969 | Hypersensitivity, Immediate |
| D006967 | Hypersensitivity |
| D007154 | Immune System Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
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