Hospital at home worldwide: Program and clinician characteristics from the World Hospital at Home Congress survey.

Abstract

Background: Hospital at home (HaH) delivers hospital-level care to acutely ill patients at home as a substitute for brick-and-mortar hospital care. The clinician and program characteristics of HaH programs worldwide are relatively unknown. We sought to describe the world's HaH clinicians and their programs' characteristics.

Methods: We analyzed a survey administered to all attendees of the 2023 World Hospital at Home Congress. Clinician characteristics included age, years worked in HaH, profession, burnout, and experience. Program characteristics included location, daily census, types of care delivery, and clinical capabilities.

Results: Of 670 attendees, about 305 were clinicians and 129 responded (42% response rate for clinicians). The majority of clinicians were 30-49 years old (65.1%), new to the field (70.5% worked less than 10 years), and part-time (18% dedicated >74% effort to HaH). Clinicians reported overall satisfaction with their job and low burnout. About half of programs were in Europe (52.1%), newly operational (44.7% less than 5 years), mostly operated in urban environments (87.2%), and mostly had a daily census of less than 25 patients (62.8%). Most programs operated 7-days per week (88.3%), performed intermittent or continuous remote monitoring (81.4%), used video communication (63.8%), and had some advanced capabilities such as in-home imaging (47.9%) and advanced procedures (23.4%). Visit frequencies to the patient's home were variable: most programs had physicians visit the home, nearly all had nurses visit the home, and fewer performed virtual visits.

Conclusions: HaH clinicians and programs have significant similarities but also a fair number of divergent practices, much like brick-and-mortar hospital care. Further standardization of the care model will help to unify the field across the globe.