title: Health care provider evaluation of a substitutive model of hospital at home.
abstract: OBJECTIVE
  To evaluate Hospital at Home (HaH), a substitute for inpatient care, from the perspectives of participating providers.
  
  
  METHODS
  Multivariate general estimating equations regression analyses of a patient-specific survey of providers delivering HaH care in a prospective, nonrandomized clinical trial.
  
  
  METHODS
  Eleven physicians and 26 nurses employed in 3 Medicare-Advantage plans and 1 Veterans Administration medical center.
  
  
  METHODS
  Problems with care; benefits; problem-free index.
  
  
  RESULTS
  Case response rates were 95% and 82% for physicians and nurses, respectively. The overall problem-free index was high (mean 4.4, median 5, scale 1-5). "Major" problems were cited for 14 of 84 patients (17%), most relating to logistic issues without adverse patient outcomes. Positive effects included quicker patient functional recovery, greater opportunities for patient teaching, and increased communication with family caregivers. In multivariate analysis, the problem-free index was lower for nurses compared with physicians in one site; for patients with cellulitis; and for patients with a higher acuity (APACHE II) score. HaH physicians and nurses differed in their judgments of hours of continuous nursing required by patients.
  
  
  CONCLUSIONS
  The health care provider evaluation of substitutive HaH care was positive, providing support for the viability of this innovative model of care. Without provider support, no new model of care will survive. These findings also provide insight into areas to attend to in implementation. Organizations considering adoption of the HaH should monitor provider views to promote quality improvement in HaH.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. jmarstel@jhsph.edu
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.forename: Lynda
authors.initials: L
authors.lastname: Burton
authors.forename: Scott L
authors.initials: SL
authors.lastname: Mader
authors.forename: Bruce
authors.initials: B
authors.lastname: Naughton
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Burl
authors.forename: Susan
authors.initials: S
authors.lastname: Guido
authors.forename: William B
authors.initials: WB
authors.lastname: Greenough
authors.forename: Donald
authors.initials: D
authors.lastname: Steinwachs
authors.forename: Rebecca
authors.initials: R
authors.lastname: Clark
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006282:Health Personnel / Q000523:psychology*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D020398:Medicare Part C; D017146:Models, Organizational; D011446:Prospective Studies; D012044:Regression Analysis; D014481:United States