Hospital Care at Home for Adults Living in Rural Settings

PURPOSE: Describe the perceptions of patients receiving rural home hospital (RHH) care. METHODS: This is a qualitative evaluation of a randomized controlled trial comparing RHH (intervention) versus brick-and-mortar (BAM) care (control) in three rural sites in the United States and Canada between February 23, 2022, and January 17, 2024. Participants include acutely ill patients who received RHH. RHH programs provided patients with twice-daily nurse/paramedic visits, daily physician visits (remote), hospital-level diagnostics and treatments in the home, and other care tailored to the patient. Patient experience while receiving RHH care analyzed thematically to identify advantages and disadvantages of this model of care in the rural setting. FINDINGS: We interviewed 38 of 79 RHH patients recruited to our randomized controlled trial. Mean age was 67 (SD 17), 100% were White, 29% female, 82% Medicare recipients, and 62% retired. Patient perceptions clustered around three main themes: (1) perceived quality of care; (2) perceived comfort; and (3) experience with technology. Overall, home hospitalized patients were satisfied with the care they received at home. This was driven by strong rapport with the care team and receiving safe and effective medical care in the comfort of their home. Patients noted perceived comfort from familiar home surroundings and improved social support, nutrition, and sleep. Patients felt technology facilitated their experience and noted it presented a learning curve and occasional barrier to care. CONCLUSIONS: RHH patients reported positive patient experiences principally across perceived quality, comfort, and technology, with some opportunity for improvement in technology interfaces for select patients. TRIAL REGISTRATION: NCT05256303.

Medical care · MEDLINE · Patient satisfaction · Patient-centered care · Perception · Qualitative research · Randomized controlled trial · Rapid response team · Rural area · Frailty in Older Adults · Geriatric Care and Nursing Homes · Intensive Care Unit Cognitive Disorders

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