Abstract
BackgroundHome-based hospitalization (HBH) offers an alternative delivery model to hospital care. There has been a remarkable increase in pilot initiatives and deployment of this model to optimize services offered to a population with a variety of progressive and chronic diseases. Our objectives were to systematically summarize the indicators of HBH as well as the factors associated with the successful implementation and use of this model.MethodsWe used a two-stage process. First, five databases were consulted, with no date delimitation. We included systematic reviews of quantitative, qualitative, and mixed studies published in English, French, Spanish, or Portuguese. We followed guidance from PRISMA and the Cochrane Collaboration. Second, we used the Nursing Care Performance Framework to categorize the indicators, a comprehensive grid of barriers and facilitators to map the factors affecting HBH implementation, and a thematic synthesis of the qualitative and quantitative findings.ResultsFifteen reviews were selected. We identified 26 indicators related to nursing care that are impacted by the use of HBH models and 13 factors related to their implementation. The most frequently documented indicators of HBH were cost of resources, problem and symptom management, comfort and quality of life, cognitive and psychosocial functional capacity, patient and caregiver satisfaction, hospital mortality, readmissions, and length of stay. Our review also highlighted new indicators, namely use of hospital beds, new emergency consultations, and use of healthcare services as indicators of resources of cost, and bowel complications, caregiver satisfaction, and survival time as indicators of change in the patient’s condition. The main facilitators for HBH implementation were related to internal organizational factors (multidisciplinary collaboration and skill mix of professionals) whereas barriers were linked to the characteristics of the HBH, specifically eligibility criteria (complexity and social situation of the patient).ConclusionTo the best of our knowledge, this is the first review that synthesizes both the types of indicators associated with HBH and the factors that influence its implementation. Considering both the processes and outcomes of HBH will help to identify strategies that could facilitate the implementation and evaluation of this innovative model of care delivery.Systematic review registrationPROSPERO CRD42018103380
Highlights
Rationale3, 4 including mention of why a network meta-analysis has been conducted
Summary of main results This systematic review of reviews provides a mapping of the indicators of the Home-based hospitalization (HBH) model, categorized by the dimensions of nursing care, as well as the factors identified as barriers or facilitators to its implementation
Our findings provide a mapping of the indicators of the HBH model, categorized by the dimensions of nursing care, as well as the factors identified as barriers or facilitators to its implementation
Summary
Home-based hospitalization (HBH) offers an alternative delivery model to hospital care. Since hospitalization is one of the key factors in the increasing cost associated with the use of health services related to chronic diseases, it is essential to implement effective and safe alternatives to conventional hospitalization [4]. Home-based hospitalization (HBH) offers an alternative model of care delivery subject to the same obligations as hospitals [10, 11]. The terminology regarding this service model is inconsistent in the literature as many studies use hospital-based home, hospital at home, hospital in the home, and home-hospitalization. The implementation of HBH would optimize the use of resources by providing health services for specific groups who do not require conventional hospitalization
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