Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, New York.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Geriatr Soc. 2019 Mar;67(3):588-595. doi: 10.1111/jgs.15782. Epub 2019 Feb 8.
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.
This study examined facilitators and barriers to implementation of an HaH program.
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.
Large urban academic health system.
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).
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.
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.
医院居家（HaH）是一种在家庭中提供急性水平服务的护理模式。HaH 已被证明可以提高质量和患者满意度，减少医源性疾病和成本。在美国，HaH 的采用受到限制，关于如何成功实施 HaH 的研究很少。
本研究探讨了实施 HaH 项目的促进因素和障碍。
通过医疗保险和医疗补助服务中心的创新奖实施了一项 HaH 计划，该计划包括急性住院后的 30 天过渡护理套餐。知情人填写了一个初步表，描述了初始实施组件、障碍和促进因素。随后进行了半结构化焦点小组和个人访谈，由两名独立调查员使用主题分析进行转录和独立编码。
大型城市学术卫生系统。
来自西奈山的临床和行政人员、纽约探访护士服务公司以及合作伙伴组织（实验室、药房、放射科和运输）的高管。
为了成功开发和实施高质量的 HaH 计划，需要通过内部与政策制定者和外部合作伙伴进行大量团队合作和沟通来克服许多障碍。至关重要的领域包括促进对监管障碍和卫生系统政策的工作规避；改变不适合 HaH 的电子健康记录；开发必要的支付和计费机制；并与外部供应商建立有效的合作关系和沟通。
在美国开发 HaH 计划是可行的，但需要进行战略规划并建立强大、紧密协调的合作伙伴关系。美国老年学会杂志 67:588-595, 2019。
