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What is Hospital-at-Home?
There is significant interest in digital treatment in the patient's own home in many countries, and numerous political trends and healthcare initiatives are generally calling for the digital transformation of healthcare systems. This is also true in Denmark, Sweden, and Norway. In this digital transformation, elements such as digital treatment, digital monitoring, and digital hospitalization in the patient’s own home are the most important cornerstones or types of hospital interventions in the home.
In contrast to home monitoring and home treatment for outpatients, home hospitalization, or "Hospital-at-Home" (HaH), is defined as a service model that effectively replaces traditional acute hospitalization. There are many differences and proposals regarding how to best and most practically design HaH models within the unique healthcare systems. What is common, however, is that HaH involves a patient who is relatively acute and formally hospitalized, but receiving care at home (or in a nursing home) while staying in contact with healthcare professionals through digital solutions and/or home visits.
Since HaH deals with acute patients, the risk profile requires the appropriate equipment to monitor vital parameters and alert staff in the event of a deteriorating condition, as well as additional training for staff (e.g., through NorDigHE training) and other measures to ensure necessary patient safety.
The World Hospital at Home Community, an international professional society in the field, has adopted the following consensus definition of Hospital-at-Home in 2023:
"Hospital at Home (...) is an acute clinical service that takes staff, equipment, technologies, medication and skills usually provided in hospitals and delivers that hospital care to selected people in their homes or in nursing homes. It substitutes for acute inpatient hospital care"
The image is taken from: "World Hospital at Home Community" https://whahc-community.kenes.com/
HaH is:
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Subject to legal regulations.
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Episodic support for consultations
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24/7 emergency care assistance
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Fully responsible for patient safety and the quality of care.
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Capable of providing comprehensive medical, nursing, observation, diagnostics, and therapy during the acute episode at home, within a safe environment.
HaH is not:
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Outpatient treatment
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A hospital prevention program
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A community-based program for the treatment of chronic diseases
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Virtual care or remote telemonitoring only
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Day facility-based treatment
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Primary home care
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Local nursing or standard home care
What is the purpose of Hospital-at-Home?
The goal of HaH is to improve the lives of acutely ill individuals who need hospitalization by providing "hospital care at home." There are generally two types of HaH models: "admission prevention" models, which aim to prevent acute hospitalizations, and "early discharge" models, which aim to discharge patients earlier than usual to shorten their physical stay in the hospital.
Is it just a cost-saving exercise? Or "hidden overcrowding"?
No. HaH is a meaningful approach that improves quality of care for many patients. Hospitalization at home can be more convenient and practical for patients. A Cochrane review also shows that HaH is generally safe for patients, increases patient satisfaction, reduces readmissions, and is cost-effective. There is also evidence of positive effects on several other relevant clinical outcomes. Additionally, HaH may help create better work conditions for healthcare staff and assist in managing the growing pressure on the healthcare sector due to demographic changes and the rise in chronic diseases, multi-morbidity, and so on.