Title: How to utilise the potential of Hospital at Home to deliver more acute non-COVID and COVID care outside of hospital
Funder: Department of Health and Social Care

Abstract: Research question How can Hospital at Home contribute to system recovery and resilience- through delivering more acute non-COVID and COVID care for newly or already vulnerable, homebound groups outside of hospital? Background Older people are more likely to: develop severe forms of COVID-19 needing hospital (critical) care and die from it, need long-term aftercare if they survive, and be affected by postponed or restricted non-COVID acute care having the greatest acute care needs. As the pandemic continues, they will continue to have the restricted access to hospital care due to concerns over iatrogenic spread of COVID-19 and reduced NHS routine Hospital capacity. There is a pressing need to deliver more acute care outside of hospital. Hospital at Home (HaH) is a service that provides acute and subacute care by healthcare professionals in private or care homes for a condition that would otherwise require acute hospital inpatient care. It treats people with a wide range of conditions in a variety of contexts, with its particular interest in the provision of services for older people with frailty. More evidence is needed to support its service development, monitoring and evaluation, and strategic and policy planning. Objectives To develop a programme theory to understand and capture what HaH services can do for the care of older people during and beyond the pandemic and how; To capture positive and negative lessons from service adaptation/setup during the pandemic; To assess the current status of HaH provision in the UK; To assess the resource use and associated costs and savings of HaH in the context of the pandemic; To design and set up a national data registry to capture activity, complexity and outcomes from HaH services. Methods This is a mixed-methods study, consisting of five interlinked components: A realist review & synthesis of existing evidence/knowledge, to develop a draft programme theory. Virtual stakeholder consultations with multidisciplinary team members, service managers and partners of HaH services and policymakers, to capture lessons learnt during the pandemic, to refine and update the theory, and to elicit resources required for various service components and major types of care packages delivered by HaH. Web-based UK HaH baseline survey to assess the current HaH provision in the UK, using descriptive statistical analysis. Comparative cost analysis, including estimation of implementation costs (set-up and recurring) and contingent costs, using publicly available costing tables and the headroom method (with sensitivity analyses). Synthesis of evidence from the survey and the theory, to create/define core data set for a national data registry. Timelines for delivery Early interim findings will be generated by Month 6 and final findings by the end of the study. Anticipated Impact and Dissemination This research initiative will produce practice and policy-relevant evidence on HaH including its impact on acute healthcare delivery and social care and other community services, and the implications of these for the NHS Long Term Plan for Ageing well . We will share findings with policymakers, service planners/commissioners, practitioners, researchers, and the public.

Lay abstract: Aim To find out how Hospital at Home (HaH) can be scaled up to provide more hospital-level care in private homes/care homes. This will benefit the most vulnerable members in our communities, particularly older people with frailty and underlying health problems. Background Older people are among the worst affected by COVID-19. They have the greatest need for hospital care but can catch COVID-19 while in hospital for treatment. If infected, they are more likely to develop severe COVID-19 and die from it. Also, hospitals have a mounting backlog of non-COVID care but much-reduced capacity. There is an urgent need to look at alternative ways of providing hospital-level care. Hospital at Home (HaH) is hospital-level, specialist care delivered in the comfort of patients own homes- a safe, effective, and cheaper alternative to hospital care. Evidence shows that it helps reduce mortality, functional decline, and hospital-acquired infections in older people while giving them better care experiences, quality of life, and chances of keeping their independence. During the pandemic, HaH became a key resource for particularly vulnerable groups and helped free up hospital capacity. To provide person-centred care, a HaH care team usually includes a range of specialists (e.g. doctors, nurses, therapists, pharmacists); works with patients and carers, and hospital, primary care and social services; and adapts to varying and complex needs of individual patients (and their carers), and local contexts. Because HaH is versatile and complex, to know how to scale it up effectively, we need to understand: how different HaH services work and the essential components for success; how HaH can be adapted to local needs, e.g. local health issues, existing services, and cultural, socioeconomic, and other diversities; where HaH services are delivered in the UK, what each service offers, and what resources are required; and how UK HaH services have adapted to COVID-19. Methods We will bring together international evidence on HaH; hold workshops with people involved in HaH services (staff, managers, partners, and policymakers); undertake a web-based survey of UK HaH services; estimate resource use and costs of HaH; and design a national data registry for HaH. PPI Five public contributors with various experiences of care helped us improve this application. They underlined the importance of the research, particularly given current pressures on hospitals and the potential for HaH to improve experience of care. We will work with 4-8 patients and carers to contribute to all aspects of research, including developing the protocol and other documents; facilitating workshops so that what matters to patients and carers are central to discussions; and developing outcome measures most important to patients and carers. Dissemination We will share findings with policymakers, service planners/commissioners, practitioners, researchers, and the public in an appropriate manner.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE