A research agenda for hospital at home

Bruce Leff; Linda V. DeCherrie; Michael Montalto; David M. Levine

doi:10.1111/jgs.17715

A research agenda for hospital at home

Bruce Leff, Linda V. DeCherrie, Michael Montalto, David M. Levine

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background: Hospital at home (HaH) provides hospital-level care at home as a substitute for traditional hospital care. Interest in HaH is increasing markedly. While multiple studies of HaH have demonstrated that HaH provides safe, high-quality, cost-effective care, there remain many unanswered research questions. The objective of this study is to develop a research agenda to guide future HaH-related research. Methods: Survey of attendees of first World HaH Congress 2019 for input on research for the future HaH development. Selection and ranking of important topic areas for future HaH-related research. Development of research domains and research questions and issues using grounded theory approach, supplemented by focused literature reviews. Results: 240 conference attendees responded to the survey (response rate, 55.3%). The majority were from Europe (64%) and North America (11%) and were HaH program leaders (29%), HaH physicians (27%), and researchers (13%). Nine research domains for future HaH research were identified: 1) definition of the HaH model of care; 2) the HaH clinical model; 3) measurement and outcomes of HaH; 4) patient and caregiver experience with HaH; 5) education and training of HaH clinicians; 6) technology and telehealth for HaH; 7) regulatory and payment issues in HaH; 8) implementation and scaling of HaH; and 9) ethical issues in HaH. Key research issues and questions were identified for each domain. Conclusions: While highly evidence-based, unanswered research questions regarding HaH remain, focusing research efforts on the domains identified in this study will serve to improve HaH for all key HaH stakeholders.

Original language	English
Pages (from-to)	1060-1069
Number of pages	10
Journal	Journal of the American Geriatrics Society
Volume	70
Issue number	4
DOIs	https://doi.org/10.1111/jgs.17715
State	Published - Apr 2022

Keywords

Hospital at home
home-based care
research agenda

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10.1111/jgs.17715

Cite this

@article{37f46e1e6e794908b0a0b05f8dcfa698,

title = "A research agenda for hospital at home",

abstract = "Background: Hospital at home (HaH) provides hospital-level care at home as a substitute for traditional hospital care. Interest in HaH is increasing markedly. While multiple studies of HaH have demonstrated that HaH provides safe, high-quality, cost-effective care, there remain many unanswered research questions. The objective of this study is to develop a research agenda to guide future HaH-related research. Methods: Survey of attendees of first World HaH Congress 2019 for input on research for the future HaH development. Selection and ranking of important topic areas for future HaH-related research. Development of research domains and research questions and issues using grounded theory approach, supplemented by focused literature reviews. Results: 240 conference attendees responded to the survey (response rate, 55.3%). The majority were from Europe (64%) and North America (11%) and were HaH program leaders (29%), HaH physicians (27%), and researchers (13%). Nine research domains for future HaH research were identified: 1) definition of the HaH model of care; 2) the HaH clinical model; 3) measurement and outcomes of HaH; 4) patient and caregiver experience with HaH; 5) education and training of HaH clinicians; 6) technology and telehealth for HaH; 7) regulatory and payment issues in HaH; 8) implementation and scaling of HaH; and 9) ethical issues in HaH. Key research issues and questions were identified for each domain. Conclusions: While highly evidence-based, unanswered research questions regarding HaH remain, focusing research efforts on the domains identified in this study will serve to improve HaH for all key HaH stakeholders.",

keywords = "Hospital at home, home-based care, research agenda",

author = "Bruce Leff and DeCherrie, {Linda V.} and Michael Montalto and Levine, {David M.}",

note = "Funding Information: Dr. Leff serves as a clinical advisor to Medically Home, Dispatch Health, and the Chartis Group. He serves as a volunteer member of the Humana Multidisciplinary Advisory Board. In the early 2000s, Dr. Leff developed FoF technical assistance tools that were licensed by Johns Hopkins to several entities and, as a result of these license agreements, both the University and its inventors received royalty income. Dr. Leff's arrangements and relationships have been reviewed and approved by the Johns Hopkins University in accordance with its conflicts of interest policy. Drs. Leff and Montalto serve as consultants to the Kenes Group as members of the planning committee of the World Hospital at Home Congress. Drs. DeCherrie, Leff, and Levine lead the HoH Users group, which focuses on HoH technical assistance and is supported by grants from the John A. Hartford Foundation. Dr. Levine has a principal investigator-initiated study and co-development agreement with Biofourmis and a principal investigator-initiated study with IBM, separate from the present work. Dr. DeCherrie was a full-time employee of the Icahn School of Medicine at Mount Sinai at the time the research was conducted and the manuscript was submitted to JAGS. The Icahn School of Medicine at Mount Sinai has an ownership interest in a joint venture with Contessa Health, a venture that manages acute care services provided to patients in their homes through prospective bundled payment arrangements. Dr. DeCherrie had no personal financial interest in the joint venture. At the time the manuscript revision was submitted, Dr. DeCherrie was a full-time employee of Medically Home. This work was supported by The John A. Hartford Foundation. Otherwise, the funder had no role in the study. Survey responses were compiled in the Qualtrics system. We describe the characteristics of our respondents and their selection and prioritization of research agenda items with simple percentages. Investigators (DML, BL) reviewed all free-text suggestions (N = 66) for additional HaH research topics. As appropriate, suggestions were assigned to the previously developed 22 potential HaH research topic areas; one additional topic area was added based on free text input. To identify and refine key ideas and themes from the data, investigators employed a grounded theory approach17 to develop research domains. Investigators, first independently, then as a group, iteratively categorized the potential HaH research topic areas into broader research domains using the data from the survey respondents. Nine research domains captured all the potential HaH research topic areas. For each domain, a focused narrative literature review was conducted to understand the current state of knowledge/research related to that domain.18,19 A Pubmed search from 1976 forward until January 2021 was conducted using the search strategy: “hospital at home” [TI] or “home hospital”[TI]. Key words associated with each of the domains were then added to this basic search term to conduct domain-specific searches. Abstracts and relevant articles were reviewed by the investigators. Each domain was assigned to an investigator who developed a draft set of research priorities and questions related to the domain, which were reviewed by all the investigators in two rounds of review for inclusion in final recommendations based on importance to advance the field of HaH. This research was approved by the institutional review board of The Johns Hopkins University School of Medicine. This work was supported by The John A. Hartford Foundation. Otherwise, the funder had no role in the study. The investigators developed a 6-question survey (see Data S1) to inform the development of a research agenda for HaH. The survey was pilot-tested by 4 HaH clinicians and refined based on their feedback. Respondents reported the continent where they worked, their main role(s) in HaH, and the number of patients treated annually in their HaH, if applicable. The survey then asked respondents to select all items that needed to be addressed in future research related to HaH from a list of 22 potential research topic areas developed iteratively by the investigators and a free-text option to add additional research topics or specific research questions to the list. From this same list, respondents were asked to select the 5 most important areas for HaH research, again with free text option. The final question asked respondents to provide any additional thoughts regarding research issues for HaH in free text. A link to the online anonymous Qualtrics survey was sent via email to all advance registrants 1 week prior to the first World Hospital at Home Congress convened in Madrid, Spain in April 2019. A reminder email was sent on the first day of the Congress. At various Congress sessions, attendees were encouraged to complete the survey. No remuneration was provided. Informed consent was obtained of respondents in the opening screen of the survey. Survey responses were compiled in the Qualtrics system. We describe the characteristics of our respondents and their selection and prioritization of research agenda items with simple percentages. Investigators (DML, BL) reviewed all free-text suggestions (N = 66) for additional HaH research topics. As appropriate, suggestions were assigned to the previously developed 22 potential HaH research topic areas; one additional topic area was added based on free text input. To identify and refine key ideas and themes from the data, investigators employed a grounded theory approach17 to develop research domains. Investigators, first independently, then as a group, iteratively categorized the potential HaH research topic areas into broader research domains using the data from the survey respondents. Nine research domains captured all the potential HaH research topic areas. For each domain, a focused narrative literature review was conducted to understand the current state of knowledge/research related to that domain.18,19 A Pubmed search from 1976 forward until January 2021 was conducted using the search strategy: “hospital at home” [TI] or “home hospital”[TI]. Key words associated with each of the domains were then added to this basic search term to conduct domain-specific searches. Abstracts and relevant articles were reviewed by the investigators. Each domain was assigned to an investigator who developed a draft set of research priorities and questions related to the domain, which were reviewed by all the investigators in two rounds of review for inclusion in final recommendations based on importance to advance the field of HaH. This research was approved by the institutional review board of The Johns Hopkins University School of Medicine. This work was supported by The John A. Hartford Foundation. Otherwise, the funder had no role in the study. Funding Information: Drs. Leff, DeCherrie, and Levine were supported by a grant from The John A. Hartford Foundation. Funding information Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.",

year = "2022",

month = apr,

doi = "10.1111/jgs.17715",

language = "English",

volume = "70",

pages = "1060--1069",

journal = "Journal of the American Geriatrics Society",

issn = "0002-8614",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "4",

}

TY - JOUR

T1 - A research agenda for hospital at home

AU - Leff, Bruce

AU - DeCherrie, Linda V.

AU - Montalto, Michael

AU - Levine, David M.

N1 - Funding Information: Dr. Leff serves as a clinical advisor to Medically Home, Dispatch Health, and the Chartis Group. He serves as a volunteer member of the Humana Multidisciplinary Advisory Board. In the early 2000s, Dr. Leff developed FoF technical assistance tools that were licensed by Johns Hopkins to several entities and, as a result of these license agreements, both the University and its inventors received royalty income. Dr. Leff's arrangements and relationships have been reviewed and approved by the Johns Hopkins University in accordance with its conflicts of interest policy. Drs. Leff and Montalto serve as consultants to the Kenes Group as members of the planning committee of the World Hospital at Home Congress. Drs. DeCherrie, Leff, and Levine lead the HoH Users group, which focuses on HoH technical assistance and is supported by grants from the John A. Hartford Foundation. Dr. Levine has a principal investigator-initiated study and co-development agreement with Biofourmis and a principal investigator-initiated study with IBM, separate from the present work. Dr. DeCherrie was a full-time employee of the Icahn School of Medicine at Mount Sinai at the time the research was conducted and the manuscript was submitted to JAGS. The Icahn School of Medicine at Mount Sinai has an ownership interest in a joint venture with Contessa Health, a venture that manages acute care services provided to patients in their homes through prospective bundled payment arrangements. Dr. DeCherrie had no personal financial interest in the joint venture. At the time the manuscript revision was submitted, Dr. DeCherrie was a full-time employee of Medically Home. This work was supported by The John A. Hartford Foundation. Otherwise, the funder had no role in the study. Survey responses were compiled in the Qualtrics system. We describe the characteristics of our respondents and their selection and prioritization of research agenda items with simple percentages. Investigators (DML, BL) reviewed all free-text suggestions (N = 66) for additional HaH research topics. As appropriate, suggestions were assigned to the previously developed 22 potential HaH research topic areas; one additional topic area was added based on free text input. To identify and refine key ideas and themes from the data, investigators employed a grounded theory approach17 to develop research domains. Investigators, first independently, then as a group, iteratively categorized the potential HaH research topic areas into broader research domains using the data from the survey respondents. Nine research domains captured all the potential HaH research topic areas. For each domain, a focused narrative literature review was conducted to understand the current state of knowledge/research related to that domain.18,19 A Pubmed search from 1976 forward until January 2021 was conducted using the search strategy: “hospital at home” [TI] or “home hospital”[TI]. Key words associated with each of the domains were then added to this basic search term to conduct domain-specific searches. Abstracts and relevant articles were reviewed by the investigators. Each domain was assigned to an investigator who developed a draft set of research priorities and questions related to the domain, which were reviewed by all the investigators in two rounds of review for inclusion in final recommendations based on importance to advance the field of HaH. This research was approved by the institutional review board of The Johns Hopkins University School of Medicine. This work was supported by The John A. Hartford Foundation. Otherwise, the funder had no role in the study. The investigators developed a 6-question survey (see Data S1) to inform the development of a research agenda for HaH. The survey was pilot-tested by 4 HaH clinicians and refined based on their feedback. Respondents reported the continent where they worked, their main role(s) in HaH, and the number of patients treated annually in their HaH, if applicable. The survey then asked respondents to select all items that needed to be addressed in future research related to HaH from a list of 22 potential research topic areas developed iteratively by the investigators and a free-text option to add additional research topics or specific research questions to the list. From this same list, respondents were asked to select the 5 most important areas for HaH research, again with free text option. The final question asked respondents to provide any additional thoughts regarding research issues for HaH in free text. A link to the online anonymous Qualtrics survey was sent via email to all advance registrants 1 week prior to the first World Hospital at Home Congress convened in Madrid, Spain in April 2019. A reminder email was sent on the first day of the Congress. At various Congress sessions, attendees were encouraged to complete the survey. No remuneration was provided. Informed consent was obtained of respondents in the opening screen of the survey. Survey responses were compiled in the Qualtrics system. We describe the characteristics of our respondents and their selection and prioritization of research agenda items with simple percentages. Investigators (DML, BL) reviewed all free-text suggestions (N = 66) for additional HaH research topics. As appropriate, suggestions were assigned to the previously developed 22 potential HaH research topic areas; one additional topic area was added based on free text input. To identify and refine key ideas and themes from the data, investigators employed a grounded theory approach17 to develop research domains. Investigators, first independently, then as a group, iteratively categorized the potential HaH research topic areas into broader research domains using the data from the survey respondents. Nine research domains captured all the potential HaH research topic areas. For each domain, a focused narrative literature review was conducted to understand the current state of knowledge/research related to that domain.18,19 A Pubmed search from 1976 forward until January 2021 was conducted using the search strategy: “hospital at home” [TI] or “home hospital”[TI]. Key words associated with each of the domains were then added to this basic search term to conduct domain-specific searches. Abstracts and relevant articles were reviewed by the investigators. Each domain was assigned to an investigator who developed a draft set of research priorities and questions related to the domain, which were reviewed by all the investigators in two rounds of review for inclusion in final recommendations based on importance to advance the field of HaH. This research was approved by the institutional review board of The Johns Hopkins University School of Medicine. This work was supported by The John A. Hartford Foundation. Otherwise, the funder had no role in the study. Funding Information: Drs. Leff, DeCherrie, and Levine were supported by a grant from The John A. Hartford Foundation. Funding information Publisher Copyright: © 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.

PY - 2022/4

Y1 - 2022/4

N2 - Background: Hospital at home (HaH) provides hospital-level care at home as a substitute for traditional hospital care. Interest in HaH is increasing markedly. While multiple studies of HaH have demonstrated that HaH provides safe, high-quality, cost-effective care, there remain many unanswered research questions. The objective of this study is to develop a research agenda to guide future HaH-related research. Methods: Survey of attendees of first World HaH Congress 2019 for input on research for the future HaH development. Selection and ranking of important topic areas for future HaH-related research. Development of research domains and research questions and issues using grounded theory approach, supplemented by focused literature reviews. Results: 240 conference attendees responded to the survey (response rate, 55.3%). The majority were from Europe (64%) and North America (11%) and were HaH program leaders (29%), HaH physicians (27%), and researchers (13%). Nine research domains for future HaH research were identified: 1) definition of the HaH model of care; 2) the HaH clinical model; 3) measurement and outcomes of HaH; 4) patient and caregiver experience with HaH; 5) education and training of HaH clinicians; 6) technology and telehealth for HaH; 7) regulatory and payment issues in HaH; 8) implementation and scaling of HaH; and 9) ethical issues in HaH. Key research issues and questions were identified for each domain. Conclusions: While highly evidence-based, unanswered research questions regarding HaH remain, focusing research efforts on the domains identified in this study will serve to improve HaH for all key HaH stakeholders.

AB - Background: Hospital at home (HaH) provides hospital-level care at home as a substitute for traditional hospital care. Interest in HaH is increasing markedly. While multiple studies of HaH have demonstrated that HaH provides safe, high-quality, cost-effective care, there remain many unanswered research questions. The objective of this study is to develop a research agenda to guide future HaH-related research. Methods: Survey of attendees of first World HaH Congress 2019 for input on research for the future HaH development. Selection and ranking of important topic areas for future HaH-related research. Development of research domains and research questions and issues using grounded theory approach, supplemented by focused literature reviews. Results: 240 conference attendees responded to the survey (response rate, 55.3%). The majority were from Europe (64%) and North America (11%) and were HaH program leaders (29%), HaH physicians (27%), and researchers (13%). Nine research domains for future HaH research were identified: 1) definition of the HaH model of care; 2) the HaH clinical model; 3) measurement and outcomes of HaH; 4) patient and caregiver experience with HaH; 5) education and training of HaH clinicians; 6) technology and telehealth for HaH; 7) regulatory and payment issues in HaH; 8) implementation and scaling of HaH; and 9) ethical issues in HaH. Key research issues and questions were identified for each domain. Conclusions: While highly evidence-based, unanswered research questions regarding HaH remain, focusing research efforts on the domains identified in this study will serve to improve HaH for all key HaH stakeholders.

KW - Hospital at home

KW - home-based care

KW - research agenda

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U2 - 10.1111/jgs.17715

DO - 10.1111/jgs.17715

M3 - Article

C2 - 35211969

AN - SCOPUS:85125175302

SN - 0002-8614

VL - 70

SP - 1060

EP - 1069

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

IS - 4

ER -

A research agenda for hospital at home

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Keywords

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