Hybrid Hospital-at-Home Program in Singapore: Ethnographic Study.

backgroundHospital-at-Home (HaH) programs deliver hospital-level care in the home setting, traditionally emphasizing high-touch, in-person clinical visits. In recent years, especially during the COVID-19 pandemic, HaH models have rapidly evolved to incorporate digital technologies, enabling remote consultations and monitoring as part of care delivery. While both in-person and remote HaH modalities have individually shown positive outcomes with patient experience and clinical safety, less is known about how hybrid models, combining both modalities, are experienced by patients and caregivers. This knowledge gap is particularly salient in Asian health care systems, where strong familial caregiving norms and blended influences of Western and traditional medicine may uniquely shape care experiences.

objectiveThis study aims to explore the experiences of patients and caregivers receiving acute care through a combination of remote consultations and in-person visits within a hybrid HaH program in Singapore.

methodsAn ethnographic qualitative research design was used to capture real-world experiences of HaH care delivery. Data collection occurred between November 2022 and May 2023 through participant observations of home visits, remote consultations, and semistructured interviews. Data were thematically analyzed using an inductive approach.

resultsThe participant observation included data from 25 patients and caregivers. A total of 4 participants were excluded from the in-depth semistructured interviews-3 were uncontactable and one was re-admitted to the hospital, resulting in a final interview sample of 21 participants. A total of three key themes, supported by 12 subthemes, were identified: (1) positive experiences of remote and home visits-participants expressed feelings of comfort, convenience, safety, and a sense of empowerment; (2) patient-provider dynamics-this theme highlighted the importance of in-person visits while noting challenges such as technology usability, complex medical communication, and difficulties in building rapport; and (3) complexities of the home as a care setting-participants reported environmental limitations, hidden financial burdens, the need for advance scheduling, perceived safety risks, and role confusion among caregivers.

conclusionsThis study underscores the multifaceted nature of delivering acute care at home through hybrid HaH models that integrate both remote and in-person visits. Physician home visits are crucial for enhancing patient and caregiver experiences, supporting remote care. Certain patient groups with limited caregiver support, dual caregiving roles, lower digital literacy, or concerns about the feasibility of home care may require more frequent in-person visits. Public education is essential to dispel misconceptions about home-based care and align societal norms around recovery at home. Financing models should also account for hidden costs to promote equitable access. Policy makers and clinicians should consider both operational needs, such as flexible coordination and digital integration, and societal factors such as varying levels of digital literacy and strong family caregiving norms when designing hybrid HaH programs, particularly in culturally diverse settings like Singapore.