Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, CV4 7AL, UK.
Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TTT, UK.
BMC Health Serv Res. 2024 Feb 2;24(1):163. doi: 10.1186/s12913-024-10619-7.
Hospital at Home (HaH) provides intensive, hospital-level care in patients' homes for acute conditions that would normally require hospitalisation, using multidisciplinary teams. As a programme of complex medical-social interventions, a HaH programme theory has not been fully articulated although implicit in the structures, functions, and activities of the existing HaH services. We aimed to unearth the tacit theory from international evidence and test the soundness of it by studying UK HaH services.
We conducted a literature review (29 articles) adopting a 'realist review' approach (theory articulation) and examined 11 UK-based services by interviewing up to 3 staff members from each service (theory testing). The review and interview data were analysed using Framework Analysis and Purposive Text Analysis.
The programme theory has three components- the organisational, utilisation and impact theories. The impact theory consists of key assumptions about the change processes brought about by HaH's activities and functions, as detailed in the organisational and utilisation theories. HaH teams should encompass multiple disciplines to deliver comprehensive assessments and have skill sets for physically delivering hospital-level processes of care in the home. They should aim to treat a broad range of conditions in patients who are clinically complex and felt to be vulnerable to hospital acquired harms. Services should cover 7 days a week, have plans for 24/7 response and deliver relational continuity of care through consistent staffing. As a result, patients' and carers' knowledge, skills, and confidence in disease management and self-care should be strengthened with a sense of safety during HaH treatment, and carers better supported to fulfil their role with minimal added care burden.
There are organisational factors for HaH services and healthcare processes that contribute to better experience of care and outcomes for patients. HaH services should deliver care using hospital level processes through teams that have a focus on holistic and individually tailored care with continuity of therapeutic relationships between professionals and patients and carers resulting in less complexity and fragmentation of care. This analysis informs how HaH services can organise resources and design processes of care to optimise patient satisfaction and outcomes.
医院居家（HaH）为通常需要住院治疗的急性疾病患者在其家中提供强化的医院级护理，采用多学科团队。作为一项复杂的医疗-社会干预计划，尽管 HaH 服务的结构、功能和活动中隐含着 HaH 计划理论，但该理论尚未得到充分阐述。我们旨在从国际证据中挖掘出隐性理论，并通过研究英国 HaH 服务来检验其合理性。
我们采用“现实主义审查”方法（理论阐述）进行了文献综述（29 篇文章），并通过采访每个服务机构最多 3 名工作人员，对 11 个英国服务机构进行了检查（理论检验）。使用框架分析和有针对性的文本分析对审查和访谈数据进行了分析。
该计划理论有三个组成部分——组织、利用和影响理论。影响理论包含了 HaH 活动和功能带来的变化过程的关键假设，这些假设在组织和利用理论中详细说明。HaH 团队应该包含多个学科，以提供全面评估，并具备在家庭中提供医院级护理过程的技能。他们应该旨在治疗广泛的临床复杂且容易遭受医院获得性伤害的患者的各种疾病。服务应每周 7 天、每天 24 小时提供服务计划，并通过一致的人员配备提供关系连续性护理。因此，在 HaH 治疗期间，患者和护理人员的疾病管理和自我护理知识、技能和信心应该得到加强，同时他们也会感到安全，护理人员在履行其角色时的负担也会最小化。
HaH 服务和医疗保健流程中有组织因素，这些因素有助于改善患者的护理体验和结果。HaH 服务应通过专注于整体和个性化护理的团队，使用医院级别的流程提供护理，团队成员之间的治疗关系具有连续性，从而减少护理的复杂性和碎片化。这种分析为 HaH 服务如何组织资源和设计护理流程以优化患者满意度和结果提供了信息。
