Just Accepted

This article has been peer reviewed and accepted for publication. It is in production and has not been edited, so may differ from the final published form.

Patient experiences and outcomes in a South Australian stand-alone hospital-in-the-home (HITH) program

Timothy J. Schultz, Candice Oster, Aubyn Pincombe, Andrew Partington, Alan Taylor , Jodi Gray , Alicia Murray, Jennifer McInnes, Cassandra Ryan, Jonathan Karnon

Abstract

Objectives. To compare clinical outcomes for patients admitted to hospital-in-the-home and traditional (bricks-and-mortar) hospitals and explore patient and carer experiences. Design. A mixed methods approach including triangulation of quantitative and qualitative data. Quantitative outcomes were compared using augmented inverse propensity weighting to adjust for differences in patient characteristics between groups. Qualitative data was collected by focus groups and interviews, and analysed using reflexive thematic analysis. Setting. Metropolitan Adelaide and one adjacent regional health network in 2020-2022. Participants. Patients discharged from either hospital setting with one of 22 eligible diagnoses. Outcomes. Mortality, rate of ED re-presentations and readmissions, length of stay and incidence of complications derived from hospital administrative data. Intervention. A newly implemented stand-alone hospital-in-the-home service. Results. Patients treated in hospital-in-the-home were less unwell than traditional hospital patients. There were no safety or quality concerns identified in the clinical outcomes. Of 2095 hospital-in-the-home patients, the in-patient mortality rate was 0.2% and 2.3% experienced a return to a bricks-and-mortar hospital during the hospital-in-the-home admission. For hospital-in-the-home patients mortality rate after 30 days was lower (-1.3%, 95%CI -2 to -0.5, P=0.002), as were re-presentations in 28 days (-7.2%, 95%CI -9.5 to -5, P<0.0001), readmissions in 28 days (-4.9%, 95% CI -6.7 to -3.2, P<0.001) and complications (-0.6%, 95% CI -0.8 to -0.5, P<0.001). Interviews of 35 patients and six carers found that hospital-in-the-home was highly accepted and preferred by patients. Hospital-in-the-home was perceived to free up resources for other, more acutely unwell patients. Conclusions. Hospital-in-the-home was preferred by patients and at least as effective in delivering quality health care as a traditional hospital, although the potential for unobserved confounding must be acknowledged.

AH24131  Accepted 02 July 2024

© CSIRO 2024