Trial reportBMJ open2019
What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial.
Trial report in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05952999 (Examining the Intervention Effectiveness of Hospital at Home for Improving Health Outcomes and Experiences for Patients, Clinicians, and Caregivers), which is not on this map. Cited by 26 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Examining the Intervention Effectiveness of Hospital at Home for Improving Health Outcomes and Experiences for Patients, Clinicians, and Caregivers
Who cites it
26 citing papers in PubMed, 8 syntheses or guidelines pooled it, 66 citations in OpenAlex.
- Implementation determinants, strategies and outcomes for scale-up of hospital-at-home: a systematic review.Implementation science communications · 2026Pooled it
- Supporting older people through Hospital at Home care: a systematic review of patient, carer and healthcare professionals' perspectives.Age and ageing · 2025Pooled it
- Dimensions and components of hospital-at-home care: a systematic review.BMC health services research · 2024Pooled it
- Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2024Pooled it
- Admission avoidance hospital at home.The Cochrane database of systematic reviews · 2024Pooled it
- Acute care models for older people living with frailty: a systematic review and taxonomy.BMC geriatrics · 2023Pooled it
- Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis.Journal of general internal medicine · 2022Pooled it
- Pooled it
- Factors affecting implementation of hospital inpatient-level care at home: a qualitative study of virtual wards in North West England.BMJ open · 2026Article
- Perceptions and anticipated factors influencing the adoption of early supported discharge through hospital-at-home.Annals of medicine · 2025Article
- Hospital-at-home care in Singapore: distilling policy and implementation strategies essential to support scale-up using Policy Labs.JBI evidence implementation · 2025Article
- Hybrid Hospital-at-Home Program in Singapore: Ethnographic Study.Journal of medical Internet research · 2025Article
- Reflections of nurses and primary healthcare managers on integrating hospital at home into public primary healthcare services: a Norwegian focus group study.Scandinavian journal of primary health care · 2024Article
- Perceptions of home hospitalization among the public and physicians in Israel: findings from surveys conducted for the Dead Sea Health Policy Conference of 2022.Israel journal of health policy research · 2024Article
- Lived experiences of older adults within an integrated hospital-at-home service: an interpretive phenomenological analysis.BMC nursing · 2024Article
- Citizens' perspectives on relocating care: a scoping review.BMC health services research · 2024Article
- An integrated understanding of the impact of hospital at home: a mixed-methods study to articulate and test a programme theory.BMC health services research · 2024Review
- Article
- Barriers to hospital-at-home acceptance: a systematic review of reasons for patient refusal.mHealth · 2024Review
- One Size Does Not Fit All: Medication Reconciliation and Review at the Hospital at Home.Cureus · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveHospital at home (HAH) for chronic obstructive pulmonary disease exacerbation selected by low-risk Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score is clinical and cost-effective; DECAF is a prognostic score indicating risk of mortality. Up to 50% of admitted patients are suitable, a much larger proportion than earlier services. Introduction of new models of care is challenging, but may be facilitated by informed engagement with stakeholders. This qualitative study sought to identify facilitators and barriers to implementation of HAH.
designSemistructured interviews, data were analysed using thematic-construct analysis.
settingInterviews were conducted within patients' homes and hospitals in North East England.
participants89 participants were interviewees; 44 patients, 15 carers, 15 physicians, 11 specialist nurses and 4 managers.
resultsFacilitators include the following: (1) availability of home comforts and maintaining independence (with positive influences on perceived rate of recovery, sleep quality and convenience for friends, family and carers) and (2) confidence in the continuity of HAH care. Barriers include the following: (1) fear of being alone at home; (2) privacy issues and not wanting visitors and (3) resistance to change. Clinician concerns occasionally delayed return home, principally during the early phase of the trial. Nurses cited higher workload and greater responsibility, but with additional resource and training; overall, they viewed HAH positively. Operational concerns included keeping medical records in a patient's home and inability to capture activity within current payment systems.
conclusionHAH selected by DECAF was preferred to inpatient care by most patients and their families. Implementation in other hospitals will require education, training and service planning, tailored to overcome the identified barriers. TRIAL REGISTRATION NUMBER: ISRCTN29082260.
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Registered trials
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