Home First! Identification of Hospitalized Patients for Home-Based Models of Care

Objectives: To determine the proportion of hospitalized inpatients suitable for an acute and subacute home-based inpatient bed substitutive service, to examine the ability of treating teams to identify suitable patients for this service, and to examine potential barriers toward inpatients receiving home-based care. Design: Prospective point prevalence study over 2 days in April 2019; analysis of responses to survey questionnaires regarding the suitability for home-based care among inpatients with multiday admissions to acute and subacute wards in the Royal Melbourne Hospital (RMH), an Australian metropolitan tertiary referral center. Setting and Participants: Ward treating teams, clinicians affiliated with the home-based service called RMH@Home, and inpatients who were subsequently identified as being suitable for home-based care. Measurements: Point prevalence and characteristics of inpatients suitable for a home-based bed substitutive service; identified by either treating teams or RMH@Home clinicians; and barriers to the provision of home-based care among ward inpatients. Results: Survey responses were received for 620 of 635 inpatients [median age 69 years (interquartile range 53–81), 53% male], of which 69 (11.1%) were identified as being suitable for home-based inpatient bed substitution care. Treating team clinicians identified 26 patients, clinicians affiliated with RMH@Home identified a further 43 suitable patients. The most commonly reported barrier (38.1%) toward receiving home-based care was functional disability impeding ability to live at home. Conclusions and Implications: A substantial proportion of hospitalized older patients could use home-based inpatient bed substitutive services. Clinicians experienced in home-based care are more skilled than ward-based clinicians in identifying suitable patients for this care model.