Analysis of the Virtual Acute Care at Home Experience

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to examine the implementation, intervention effectiveness, and dissemination of a digital acute care delivery model for improving selected health outcomes in the Hospital at Home population.

Detailed Description
-----------------
The investigators will conduct a mixed-methods quasi-experimental research study that will explore the effectiveness of the Hospital at home programs using qualitative interviews and quantitative data as a means to also conduct a process evaluation related to the implementation and efficacy of Hospital at Home programs. The purpose of this pragmatic study is to inform scalability beyond the initial site for implementation within a large healthcare system with a diverse patient population located in various communities, including rural and urban locations.

Official Title
-----------------
Examining the Intervention Effectiveness of Hospital at Home for Improving Health Outcomes and Experiences for Patients, Clinicians, and Caregivers

Conditions
-----------------
Conditions, Infections, Heart Failure, Renal and Urinary Disorders, Diabetes, Hypertension, Fever, Bronchitis, Asthma, Chronic Obstructive Pulmonary Disease (COPD)

Intervention / Treatment
-----------------
* Other: Digital Care Solution as supportive personalized care
* Other: Traditional Hospital Level Care


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients 18 years and older who are admitted into the Hospital at Home program after presenting to the emergency department or who are inpatients that can be cared at home for hospital level needs Patients meeting the hospital's criteria for admission by diagnosis type (e.g., heart failure, respiratory infections and inflammations, renal failure, diabetes, pneumonia, bronchitis, chronic obstructive pulmonary disease, fever and inflammatory conditions, viral illnesses, other disorders of the nervous system). Diagnoses are determined by clinicians not researchers. Patients will need to reside within 30 minutes' drive time from the hospital Patient caregiver inclusion criteria: (not required for patient participation): Age >= 18 years old as capacity to consent to study Clinician or stakeholder inclusion criteria: Any member of the home hospital clinical team (a healthcare professional who providing care or equipment for use in the home) who will be participating in delivery of healthcare services, Any member of the hospital care teams, including the screening and recruitment of patients for the home hospital intervention and/or providing care to patients that enroll in the intervention that is provided Any member of the leadership team who are involved in the operational aspects of program delivery Exclusion Criteria: Need for long-term facility level care or current residence in a facility of this type No one will be excluded on the basis of sex or race

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hospital at Home Care<br>The population for this study includes adult patients who are acutely ill and presenting to the emergency room, and are discharged to their home for hospital-level care in the home setting. The patients in this cohort may also include those who are discharged from the hospital early, but receive hospital-level care in the home setting. | Other: Digital Care Solution as supportive personalized care<br>* Patients will need to meet screening and inclusion criteria at time of enrollment. As a pragmatic study, researchers will not determine criteria or management of care aspects for patients.<br>* Other names: Traditional Hospital Level Care;|
| Traditional Hospital Care<br>The population for this study includes adult patients who are acutely ill and presenting to the emergency room who elect not to be discharged, choose to be cared for in the hospital setting. | Other: Traditional Hospital Level Care<br>* Patients will be cared for in the inpatient setting for management of diseases that meet screening and inclusion criteria at time of enrollment for hospital at home. As a pragmatic study, researchers will not determine criteria or management of care aspects for patients.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite of all-cause mortality for patients admitted to digital hospital | Total number of deaths over total number of patients admitted to the digital hospital. | Up to 30 days, (date of death from any cause, whichever came first, assessed up to 30 days) | 
| 30-day readmission rate | Number of 30-day readmissions as defined by Organization using preset criteria | Up to 30 days (date of readmission from any cause, whichever came first, assessed up to 30 days) | 
| Patient Satisfaction at discharge | 1-item measure: I would recommend this [insert program name] to others, assessed at discharge name] to others. | up to 1 week | 
| Patient Perception of Digital Care at discharge | Results of Digital Care - Likert Scale (very satisfied to very dissatisfied) | up to 1 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Escalations (for management and treatment of early decompensation) | percentage of patients escalated over total hospital digital encounters | up to 2 weeks | 
| Unplanned readmission within 30-days of discharge | Number of 30-day readmissions over total number of discharges | up to 30 days | 
| Length of Stay | Day of admission to day of discharge, assessed up to 2 months | assessed up to 2 weeks | 
| Number of participants with Hospital Acquired Infections | Number of hospital acquired infections reported (CAUTI, CLABSI, etc.) | assessed up to 1 week | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
home hospital, hospital at home, hospital in the home