Background
Hospital-at-home (HaH) is an alternative model of care that delivers acute and intensive medical care requirements in a community setting, namely an individual’s home [1‐3]. Bolstered by the exploration and refinement of remote care models during the Covid-19 pandemic, admission, monitoring, intervention, and discharge procedures within HaH services have evolved and gained validation [1, 4‐7]. Extensive examination of the safety and effectiveness of the HaH care model has been conducted, drawing upon empirical quantitative data [3, 8‐11]. Beyond the changing landscape of institutions and hospitals and technology advancements [12‐16], it remains imperative to address the challenges and evaluate patient experiences in order to enhance the quality of HaH care delivery [17, 18].
The HaH literature consistently underscores the necessity of cultivating active patient engagement in decision-making, optimizing resource utilization, and prioritizing person-centred care in delivering hospital-level services within a home environment [19‐26]. Within the United Kingdom, these foundational elements have been integrated into HaH services, aligning with the framework of the Integrated Care System within the National Health System (NHS) [27]. Additionally, well-considered set of 10 principles, designed to foster collaboration with individuals and communities, has adeptly guided the path of clinical practice within HaH services [28]. Within this comprehensive framework, HaH services integrate with other critical components such as intermediate care and community care [29, 30], thereby amplifying patients’ experiences and understanding. The weight accorded to these experiences is of importance, as they are shaped through active participation and influenced by the family involvement and interactions with healthcare professionals [31].
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Despite this, there is a gap in the literature on how patients and caregivers perceive and engage with HaH services in the wake of the pandemic’s aftermath [18], even though there was wide adoption of the HaH care model for healthcare delivery during the Covid-19 pandemic [16]. This study aims to build upon insights extracted from a previous scoping review [32] by specifically examining the integrated HaH service within the NHS system through the users’ perspective. The primary objective is to explore the experiences and perceptions of older adults who have received HaH services, with the goal of informing future quality improvement initiatives.
Methods
Study design
This study employed a qualitative approach using semi-structured interviews. This design supported participant-centered interaction, enabling the researcher to explore the nuanced ways in which older adults perceive and interpret their experiences with HaH services. It also provided the flexibility to probe deeper into participants’ responses, ensuring a thorough understanding of the study’s objectives [33]. Findings were reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines.
Study setting
The investigation focused on individuals served by Guys and St Thomas’ @home service, an acute community service to serve the residents of Lambeth and Southwark in London, UK. The primary goal is to prevent hospital admissions and facilitate early discharges from acute hospital settings [29, 30]. This is achieved through a multidisciplinary approach and supported by integrated teamwork. Typically, patients receive visits for a period of seven days or less and may require up to three visits in a single day, which operates year-round, from 8 am to 11 pm, managing up to 3000 patient contacts per month.
Participants and recruitment
One trained investigator facilitated the recruitment of participants. Using purposive sampling, participants were identified by the HaH team in May 2023 who had recently received care through the service, had completed care, and expressed a willingness to share their experiences.
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Data collection
Participant interviews were conducted by experienced qualitative researchers over an online platform (Microsoft Teams) while HaH nurses visited the patients’ homes and provided the iPad for interviews to take place. This approach was chosen to provide a familiar environment for the participants, encouraging them to openly share their experiences, and also facilitating the participation of close family caregivers as appropriate. A predetermined set of questions guided the interviews, focusing on: [1] lived experiences within the HaH service; [2] satisfaction of HaH service; [3] perceived education and training; [4] family involvement.
The interviews were conducted by two researchers (GL and XW), both of whom have expertise in HaH-related research and were deeply familiar with the healthcare system being observed. With participants’ consent for video recording, one researcher (GL) led the interviews, while the other (XW) made complementary observations and took textual notes. Special attention was given to observing patients interacting with their family caregivers and their movements within the home, which provided valuable context for better understanding their verbal expressions. This combined approach of direct observation and interaction aligns with the empiricist focus on gathering knowledge through sensory experience. Moreover, it enhances objectivity by minimizing researcher bias during data collection, ensuring the acquisition of in-depth qualitative data [34]. The structured yet flexible design of the interviews allowed for probing questions and adaptive responses, facilitating the collection of rich, comprehensive data necessary to capture the complex and multifaceted experiences of patients within the HaH service [35]. After each interview, the two researchers conducted thorough discussions to review the interview and observational data, ensuring completeness and addressing any ambiguities.
Data analysis
The IPA method was employed as a structured approach to delve into how individuals construct meaning within their personal and social spheres, facilitating a profound comprehension of their perceptions and interpretations [35, 36]. In accordance with recommendations from earlier studies [35, 37], the research included a smaller sample size, aligning with the suggested range of 4 to 10 participants. A total of 35 patients were approached for invitations, with data saturation achieved after interviewing 7 participants. All participants were designated with pseudonyms to ensure confidentiality.
Guided by the IPA framework, researcher XW transcribed the interviews verbatim and conducted an initial review of the collected data within 24 h post-interview. Each transcript was read multiple times to promote deep immersion in the material. Using Excel software, data related to patients’ previous history of acceptance or decline of HaH care, lived experiences of patients and caregivers, satisfaction with HaH services, family involvement, and perceived burdens were segmented into coherent units. Significant statements reflecting participants’ perceptions and interpretations were annotated with relevant comments. Each interview transcript, reflecting potential divergences in HaH service practices and unique participant perceptions, was analyzed individually. The transcripts were tabulated and coded to capture descriptive, linguistic, and conceptual elements of the data. An inclusive and iterative process was employed, utilizing thematic analysis to identify overarching themes. Segments and notes from each transcript were synthesized into cohesive themes, which were then compared across all participants to identify recurring patterns and variations. This comparative analysis facilitated a nuanced understanding of the participants’ experiences and highlighted the complexities inherent in their narratives. Findings for each subtheme and theme were contextualized within the broader philosophical framework of participants’ experiences and feedback on HaH services, ensuring the analysis reflected both individual and collective interpretations.
Both researchers engaged in comprehensive discussions to illuminate the contextual and cultural factors reflected in the interview transcripts. For instance, they interpreted participants’ experiences with HaH services in relation to cultural elements sensitive to participants’ backgrounds, including educational attainment, the role of family caregivers in healthcare, expectations regarding health outcomes, notions of familial duty, and beliefs about home-based versus institutional care. These factors were recognized as influential in shaping perceptions of autonomy, caregiving roles, and the quality of healthcare services experienced by participants. Notably, the two researchers possessed different cultural backgrounds and research experiences, which enriched the analysis. They maintained a reflexive stance, documenting their assumptions and personal experiences related to HaH services to enhance objectivity. Any ambiguities arising from differing practices within the HaH service prompted them to consult with another researcher who managed the service for clarification. This self-awareness and collaborative approach enabled them to analyze the data more objectively, minimizing the risk of imposing their cultural biases on participants’ narratives.
Underpinning a HaH-specific care experience conceptual framework developed in a previous study [32], an initial inventory of themes emerged during the preliminary phase of this analysis through inductive examination of interconnected themes. These themes were systematically organized into categories, incorporating both higher-level overarching concepts and more nuanced subordinate subcategories. This structured approach ensured a comprehensive analysis that accurately captured the complex experiences of participants within the HaH service.
Rigours
The study adopted a rigorous approach, drawing from IPA’s conception of the double hermeneutic. To enhance the credibility and robustness of the findings, the study employed five expressions of rigor proposed by Witt: balanced integration, openness, concreteness, resonance, and actualization [38]. This methodological choice emphasized an engaged collaboration between participants and researchers to jointly interpret the HaH service significance.
The interviewer team consisted of two researchers, both experienced in qualitative research. They engaged in methodological learning and real-world practice to prepare for the study. Throughout the interview process, the team maintained a balanced integration of both participants’ lived experiences and the researchers’ knowledge of the HaH care model. The philosophical framework was alternated and balanced with the voices of the study participants during the analytical process. For example, participants’ beliefs about gratitude and the meanings of family were interpreted in relation to their perceptions of family-centered care within the HaH service. In terms of openness, the semi-structured interview design facilitated the use of open-ended questions, allowing participants to share their perspectives freely. Researchers refrained from imposing judgments on participants’ expressions, focusing instead on active listening and clarification. This approach ensured that multiple viewpoints and feelings were documented as informative details. Conducting interviews in participants’ homes provided an intimate and contextual understanding of their experiences.
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To achieve concreteness, the researchers immersed themselves in the observed health system and area to gain a deeper understanding of the physical environment of the HaH care service. This hands-on involvement fostered profound engagement with the real-world dynamics of the HaH service, aiding in the interpretation of participants’ expressions and aligning findings with actual HaH practices. Furthermore, the resonance of the research was enhanced by encouraging participants to articulate their perceptions and experiences in their own words. The analysis was inclusive, aiming to produce cohesive findings that accurately reflected participants’ lived experiences. Actualization was achieved by consulting with the HaH care team and the interviewed participants, connecting the themes derived from the analysis back to the broader context of healthcare practice. This aimed to inform improvements in HaH services based on insights gathered from patients’ experiences.
Results
This study involved conducting interviews with a total of seven participants: five older adults, comprising two males and three females, with ages ranging from 72 to 89 years and two family caregivers. The patients showcased a diverse spectrum of medical conditions, ranging from heart failure, diabetes, liver diseases, kidney diseases, cancer, to other acute syndromes necessitating immediate medical attention. Two individuals had prior experience with the HaH service, while the remaining three had experienced HaH for the first time. In summary, the findings revealed four prominent themes, each accompanied by its distinct set of interpretive approaches and associated subthemes (see Table 1).
Table 1
Themes and subthemes generated in this study
Themes | Subthemes |
|---|---|
(1) Positive experiences of using HaH service | 1a: Safe and comfortable home environment |
1b: Appropriate and efficient home care | |
1c: Scheduled and adequate home visits | |
1d: Competent and supportive home team | |
(2) Supporting family-centred care within HaH service | 2a: Shared decision-making |
2b: Family attitude and anxiety | |
2c: Family involvement and burden | |
2d: Family interdependence | |
(3) Perceived challenges faced by individuals and caregivers in HaH | 3a: Resource availability and concerns |
3b: Patient-informed and record-keeping practices for HaH treatment | |
3c: Being trapped in the home context | |
(4) Messages for quality improvement of HaH service | 4a: Straightforward care plan |
4b: Integrated approach for transitions of care | |
4c: Illness-specific education |
Theme 1: Positive experiences of using HaH service
Subtheme 1a: safe and comfortable home environment
HaH service delivered a high level of professional care directly within patients’ homes, acknowledging their inclination for a familiar setting. As participants pointed out, home care offered two evident advantages: enhanced sleep quality and able to manage their diet and meals. Moreover, it effectively tackled the challenges posed by family isolation and the scarcity of medical resources (as well as staff shortages, there have been strikes amongst doctors and nurses in hospitals in the UK and so services have been reduced in hospital settings).
The familiar home environment allowed them to encounter a sense of stability and emotional attachment to their treatment, fostering a more positive healing experience.
[…] and you think home is going to save you, you think if I can just get home, there’s a security in that […] So, it wasn’t just about having the treatment, it was just the reassurance that you were stable basically […] It actually gave total peace of mind knowing that someone was gonna come and do your stats every day. -Participant Five.
Subtheme 1b: appropriate and efficient home care
A pivotal foundation of the HaH service was the regular health assessments, encompassing continual monitoring and timely interventions. Furthermore, the HaH program showcased an extensive repertoire of services designed to precisely meet medical requisites of individuals, including intravenous fluids and drug administration such as antibiotics and diuretics, supplemental oxygen and physiotherapy for example and patients could have between 1 and 4 visits a day depending on their clinical needs.
By providing such services, the HaH program ensured that patients received a level of care comparable to what they would receive in a traditional hospital setting.
Quite happy with that because they were doing just as good as they were in the hospital anyway. -Participant One.
Subtheme 1c: scheduled and adequate home visits
Regular home visits are central to the HaH service, as they were tailored to the acuity of patients and specific dependence on professional care. Participants found each visit to be valuable, effectively addressing their needs. Although all participants appreciated the busy schedules of HaH staff, they expressed a desire for specific times for their visits as opposed to any time during the day.
They came around more so, for example, they would do at least one day or not once every day for like a whole week, although even come in twice a day, I’m not reassured me a lot knowing that, OK, so they’ve come to see how she is. -Participant Two [Daughter].
Subtheme 1d: competent and supportive home team
During each visit, patients and their families closely observed the HaH team, with medical supplies, the information shared, and the overall quality of care delivered. Some participants actively engaged in seeking more information and found the team to be supportive, responsive, and well-informed in answering their queries. Overall, participants and their families displayed a strong sense of trust towards the HaH staff.
I felt like we both, everyone felt reassured. It just felt like they were. They were caring for her care. […] they’ll try to give her the best quality of care and they were lovely when they came in. -Participant Two [Daughter].
Theme 2: Supporting family-centred care within HaH service
Subtheme 2a: shared decision-making
Several patients demonstrated proactive engagement and a strong sense of involvement in the decision-making process, particularly those who highly valued their mental clarity and had specific health demands. One patient stressed, “I knew what I should be getting, and my mind still worked”. These patients actively participated in determining their medication treatment, engaging in discussions with the healthcare team, and involving their spouse and children in important conversations related to their care. Additionally, one individual made a point of attending hospital-organized patient consultation meetings.
Throughout this process, the patients’ physical and emotional needs received significant consideration from their families, especially in decisions relating to hospital discharge and readmission, facilitated by both telephone and in-person communication.
My daughter, like, indeed she got in touch with the notion of somebody was coming from Lewisham to check me out first. And they did come […] And didn’t they said yes, we’ll send you to hospital […] So they got the ambulance in that. -Participant One.
Subtheme 2b: family attitude and anxiety
All interviewed participants were living with their families. Many patients expressed agreement that their families were pleased to have treatment delivered at home. They sensed their caregivers’ positive attitude towards home care. However, one patient provided a contrasting perspective, stating, “It’s nothing about my family wanting me to be treated at home.”
Additionally, one caregiver expressed feelings of anxiety regarding their abilities to provide proper care. The caregivers’ concerns revolved around ensuring they could effectively meet the medical and emotional needs of their family members receiving home care.
I was very anxious about her coming home because I didn’t feel […] that she was ready to come home, and I spoke to them like a lot of the time, in terms of her because she went in cause of her […] why I was anxious cause I was like, how would I measure it (potassium) myself? […] how we gonna maintain it? -Participant Two [Daughter].
Subtheme 2c: family involvement and burden
Patients recognized the significant role their caregivers played in actively monitoring their health status and facilitating communication with the HaH team, primary care doctor, and hospital readmissions as needed. Some caregivers made efforts to be present during each home visit, demonstrating the dedication and responsibility they felt towards their family member’s care.
I’ve always made a point of, on the day when we know someone’s coming, I will stay at home and to make sure that I actually am here. -Participant Four [Wife].
All patients highly valued the support shown by their caregivers in assisting and managing their daily care and medical treatments. Two patients were also mindful of the potential burden and inconvenience that such involvement might impose on their caregivers’ daily routines. Interestingly, despite this awareness, patients reported no concerns from their caregivers regarding the caregiving burden.
They were quite happy because once I was out of the hospital, I was improving all the time. - Participant One.
Subtheme 2d: family interdependence
The caregiving interactions unveiled a multifaceted array of sentiments, from individuals acknowledging their reliance on family members to others deeply appreciating and reevaluating the caregivers’ contributions. Both patients and caregivers recognized the value of companionship, particularly when dealing with chronic long-term conditions on a daily basis. They understood that having someone at home with them was invaluable. A conversation between one patient and his wife epitomized this sentiment: “And as he says, it’s well, he’s been married to a nurse for over 60 years.” “I (think it) is the best thing I did was to marry you. it’s all about the family.”
Theme 3: perceived challenges faced by individuals and caregivers in HaH
Subtheme 3a: resource availability and concerns
Patients reported that the HaH program did not offer extra healthcare equipment, and health monitoring was conducted either by their primary care physicians (i.e. General Practitioners) or the HaH staff during their visits. The level of convenience experienced by patients varied depending on the availability of GPs and community nurses, alongside individuals’ access to community services.
So in terms of like her blood pressure […]. She doesn’t normally test herself, but we don’t have like things like that (measuring equipment) in the house. […] she would normally go to the GP, but with her mobility she can’t. -Participant Two [Daughter].
Patients highlighted additional resource constraints relating to information acquisition and specialist resources in the HaH program. Challenges included struggling with technology and email communication that affected access to crucial information and communication with healthcare providers regarding treatment plans. Additionally, some patients had questions about their treatment that occasionally exceeded the scope of professionals’ knowledge, resulting in brief responses. This left them seeking more comprehensive answers and assistance from specialist care teams in hospitals.
Subtheme 3b: patient-informed and record-keeping practices for HaH treatment
Some patients encountered difficulties in understanding the purpose of each visit, and this sometimes left them feeling obligated or uncertain about current situations. The absence of clinical review coordination among different team staff further hindered the development of strong patient-team staff relationships, limiting their ability to assess changes in the illness and evaluate treatment outcomes effectively. This could be attributed to the diverse services accessible in the UK, encompassing primary care (such as GPs, primary care nurses, and pharmacists), district nurses, and community services as some of the patients were receiving on-going care in their home from other community-based services.
In response, both patients and caregivers recognized the significance of developing personal strategies and approaches to self-care and health management, such as maintaining written books or records to keep track of their treatment, medical progress, and appointments. However not all patients adopted such record-keeping practices, highlighting different levels of health literacy and behaviour adherence.
It’s good that there’s a huge amount of people coming in, but there’s so much people come in that you can’t really keep up with everything […] He had the date, and it was actually very useful because they went back through our little notebook of weights (patient weight) and also they on occasion at one or other doctor quite often went back on our various sort of ordinarily written up notes. -Participant Four [Wife].
Subtheme 3c: being trapped in the home context
While undergoing HaH care, two patients articulated feelings of distress that was rooted in their previous hospitalization experiences and amplified by the chronic nature of their illnesses and overall health status. They were in the process of adapting to the necessity of being primarily confined to houses. Consequently, the notion of “home” took on a different and at times complexity meaning for them.
But actually, there’s a realization this and how poorly you actually are, and even though you’re home, the thought of home saving you. it can’t because your reality is at deals still really unwell […] -Participant Five.
Theme 4: messages for quality improvement of HaH service
Subtheme 4a: Straightforward care plan.
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Some patients shared that they were not required to perform self-care tasks during HaH care. They acknowledged the importance of monitoring their health, such as weight, blood pressure, and blood glucose for instance. However, they also expressed that the instructions provided by healthcare professionals were insufficient, fragmented, and random, or lacked clarity. The information they received seemed to be highlight the absence of detailed planning for their HaH care.
For example, it would have been nice to have like a straightforward plan […] that was the one thing I kept on asking is when we go home, what can we do? What can we do instead of randomly getting? -Participant Two [Daughter].
Subtheme 4b: integrated approach for transitions of care
Patients’ perceptions of continuity of care within the HaH program varied, sometimes leading to conflicting evaluations. Some patients felt that the HaH service was well-integrated, forging smooth connections between primary care and the acute hospital setting. Though uncertain about its efficiency, they generally appreciated the sense of being taken care of by a comprehensive and supportive network.
When it was our heart failure, specialist nurse who said I think I need to refer you to the at home team […] I don’t know whether they’ll be able to take you on at the moment because they’re very, very busy, but in fact they did. They took us on that day and also said it when they had got things finally sorted and they were happy about it. They said, comprehensive report will go to have your GP and also to your heart specialist. -Participant Four.
However, one patient reported experiencing less support from her home team and other related services. She expressed her unpleasant experience during the transition between hospital and home, where she felt that there was no specific further treatment plan in place. In addition to this, two other patients mentioned that having a stable home care team could help mitigate the energy required for initiating introduction conversations. They believed that familiarity between patients and healthcare providers would be more beneficial to the coordination of care.
Subtheme 4c: illness-specific education
Some patients highlighted a significant gap in illness-specific education and training before transitioning from the hospital ward to the HaH program. One patient noted that to improve the educational support provided, it would be beneficial for healthcare professionals to tailor the information to each patient’s specific needs and ensure that it is easily understandable. The focus of the education should be on the continued steps and phases of the illness recovery journey, empowering patients and their families with the knowledge and resources they need to navigate the HaH program effectively.
I think if you are gonna give something to somebody and also people that are at different stages of learning and intelligence. I think it just needs to be whatever it is. […] be very clear and very simple. […] You can’t always assume that someone got access to a phone, or an iPad, or even a laptop. -Participant Five.
Discussion
Prior to discussing the main findings, it is worth noting that patients preferred HaH to being admitted to hospital. This supports a growing acceptance of the HaH concept, particularly when contrasted with results from studies predominantly conducted before Covid-19 [39‐41]. Nevertheless, it’s imperative to acknowledge the prevailing constraints that call for continuous refinement and enhancement of the HaH service.
In general, there exists a clear necessity to enhance the introduction of the HaH service to ensure comprehensive awareness among both patients and caregivers. This includes not only outlining the function and role of the HaH service but also involves providing guidance on effectively managing illnesses and defining individual roles, work, and responsibilities within the service framework [42]. Within this study, it was the first-time HaH users who had a limited understanding of its functionalities. Conversely, patients who have previously used HaH were more likely to understand the service and this allowed them opportunities to develop personalized strategies to integrate and optimize the benefits [19, 43, 44]. Similar to findings from other studies [19, 20, 45‐47], aspects such as the comfort and convenience of home environments, the competency of healthcare professionals, the frequency of home visits, and the appropriateness of service content are integral in ensuring safety and effectiveness. Additionally, the enhanced sleep quality and improved appetite observed among HaH patients underscore the service’s inherent benefits, in line with earlier findings [48]. These elements hold considerable significance in shaping users’ perceptions and contribute to creating positive experiences and meaningful interactions with the HaH service.
Furthermore, a strong emphasis on advancing family-centred care was noted extending the patient-centred approach inherently ingrained in community-based home care [49], and also to the HaH care model. The presence of family caregivers and the provision of both physical and emotional support all contribute as facilitators to patients’ recovery [50, 51]. This study showcased that the family’s stance significantly influences patients’ choices concerning the adoption of HaH care, profoundly shaping their perceptions of the home care’s quality. Riffina advocated the collaborating, dividing, focusing approaches to effectively involve family caregivers in primary care [52]. This demonstrates a recognition of patients’ preferences and their requirements in selecting care settings, and is one endorsed by caregivers, and plays a vital role in shared decision-making [49], especially for older patients who often have lower health literacy and cognitive capacity [42]. The study also affirmed that the augmentation of family-centred care is closely linked to reduced levels of stress, anxiety, and depression, whilst concurrently fostering satisfaction and good rapport with healthcare providers [53]. These positive outcomes stemming from family involvement are not only feasible but also beneficial for the sustained success of HaH care [54]. Moreover, family-centred approaches establish mutually beneficial partnerships among healthcare providers, patients, and families in healthcare planning, delivery, and evaluation.
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The study’s findings shed light on the challenges faced by patients and their caregivers, illuminating their expectations and recommendations concerning the service. The HaH care model is anticipated to equip users with a range of resources, including equipment, written instructions, a streamlined care plan, integrated community care resources, sustained continuity of care spanning both hospital and home environments, and training regimens tailored for both patients and caregivers [55, 56]. However, certain gaps persist, as outlined by patients’ perceptions and assessments. Mirroring the sentiments expressed by patients, the healthcare team demonstrated a prevailing sense of business, operating under a rotating schedule, underscoring the recurring themes of suboptimal communication, the heavy workloads, and the intricate challenges intrinsic to HaH practice [15, 57]. Consequently, this interplay prompted an interactive process revolving around the reception of care at home, motivating them to propose enhancements like a personalized health record, familiarity with the healthcare team (i.e. the same healthcare professional for each visit giving continuity of care), designated visiting hours, and targeted education regarding their specific illnesses. Some of these issues were categorized as systemic or institutional constraints, as echoed in other studies [19, 20, 23]. Over time, with the ongoing advancement of remote monitoring technology, telemedicine support, and adaptive case management, there is a hopeful prospect for enhancing the overall patient experience and outcomes [14, 58].
The study findings could potentially be limited by the sample size and the distinct contexts within which the HaH practice takes place. There’s an anticipation for the expansion of coverage concerning various acute care needs and a broader diversity of patient characteristics. Additionally, the experiences drawn from a specific health system and pre-established healthcare services, tied to the study, might limit the generalizability of the results, even though the study’s design remains aligned with the universally recognized essence of the HaH care model. However, by blending a robust theoretical foundation with immersive hands-on engagement, the study ensured a comprehensive and thorough exploration of the inherent experiential significance within the HaH service in the post-Covid era.
Implication for future research and practice
This study captured valuable lived experiences and perspectives of patients and caregivers within the HaH service, offering crucial insights for its future development, improvement, implementation, and potential scaling across the globe. Aligned with the proposed research agenda from the World Hospital at Home Congress [18], the themes identified advocate for the creation of a HaH-specific conceptual framework and the development of an assessment tool to evaluate care experiences. These findings also contribute to broader contextual studies, extending across diverse cultural, socioeconomic, and geographic contexts, beyond the well-established HaH models in countries such as the United Kingdom, the United States, and Australia. The positive patient evaluations, which highlight the effectiveness of the HaH care model, suggest that its structure, components, and capabilities could be adapted and enhanced in regions seeking to implement similar programs. These insights could inform operational strategies for HaH services in countries launching new initiatives.
From a practical perspective, future research should focus on designing and implementing tailored interventions to improve the quality of HaH services based on participants’ specific needs and preferences. These interventions might include additional support mechanisms for family caregivers and relevant training programs to enhance overall care quality. Moreover, such findings can inform policymakers about the significance of integrating family-centered approaches within HaH service models, ensuring that care delivery better aligns with the lived experiences and expectations of patients and caregivers.
Conclusion
The insights gained from this study not only provide valuable guidance for advancing the HaH care model and its practical implementation, but also hold the promise of optimising and improving the HaH service.
Acknowledgements
The authors extend their gratitude to the entire @Home service team and the participants who generously shared their real-life experiences for the purpose of this study. Xiyi Wang was grateful to K.C. Wong Foundation Fellowship for supporting her research at King’s College London.
Declarations
Ethics approval and consent to participate
The study was approved by KCL College research ethics committee (MRA-22/23-37661). All participants were provided with information sheets and consented to participate before the video recording.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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