Hospital at Home

Canadian Study Focuses on What Patients and Family Caregivers Need and Want

The current issue of the Patient Experience Journal (PXJ) includes a study of perceptions among healthcare providers and the public of the “hospital at home” or HaH model of care. The study was performed in British Columbia, Canada, during the coronavirus pandemic, between September 2020 and January 2021.

HaH programs provide hospital-level acute care to patients in their homes. Through a combination of reliable communication, home visits and remote monitoring, HaH programs deliver safe, high-quality care to patients who have been identified as appropriate for this model of care. The benefits can include patient satisfaction, lower cost, and less pressure on inpatient facilities during times of high demand, such as surges of COVID-19. HaH programs have been in use in countries across the world, including Australia, the United States and the United Kingdom, for roughly 25 years and gained traction during the pandemic. HaH was introduced in British Columbia starting in late 2020 in response to COVID-19.

Photo by Breno Assis on Unsplash

In early planning for the HaH program in British Columbia, the research team found that past studies of HaH programs tend to focus on outcomes and do not include input from patients and family/friend caregivers (PFCs) about the program’s design, implementation or evaluation. The Canadian team deliberately included patient partners as active members as it designed a public engagement initiative, with two goals:

  1. To learn how to define and measure success for HaH by listening to all stakeholders.
  2. To ensure that the priorities of all stakeholders are included in design and implementation of the HaH program.

To solicit input from stakeholders, the team used an online survey that was promoted among healthcare staff members within one provider organization and to the public through traditional and social media. The team also performed a number of “key interviews,” which are not reported in detail in the published article.

The online survey netted 784 responses, 238 of which were from patients and 305 were from family caregivers. Some of the key takeaways included:

“…patients’ top priorities were seeking assurances around safety and effective communication”

“Family caregivers’ top priorities were ‘sufficient supports from clinicians and support workers,’ with 86% of the respondents rating this as ‘very important’; ‘responsiveness of clinicians to caregivers’ questions and concerns’ (83%); and having a ‘clear understanding of expectations and the caregivers’ roles’ (82%).

“When family caregivers were asked to rate which factors they perceived as barriers in participating in the HaH program, the ‘emotional toll of caregiving’ was rated as a ‘big barrier’ or a ‘very big barrier’ in 57% of responses.”

The research also revealed the degree to which both members of the public and healthcare professionals were unfamiliar with the HaH concept. The authors report that based on what they learned from the survey and interviews, communication tools and strategies were included in the HaH program, e.g., a “virtual call bell” and a voice and text messaging platform.

The care with which the research team included PFCs in planning and the detailed results reported in the article, are impressive and worth reading. All articles in PXJ are available through open access.


Susan Carr Susan Carr is a medical editor and writer specializing in patient safety and engagement. In addition to curating the EngagingPatients blog, she produces publications for the Betsy Lehman Center in Boston and the Society to Improve Diagnosis in Medicine. Susan lives and works in Lunenburg, Massachusetts.

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