Practice Standards for Acute Hospital Care at Home

Background: Hospital at home (HaH) provides hospital-level care at home as a substitute for brick-and-mortar hospital care. Multiple HaH studies demonstrate HaH provides safe, high-quality, cost-effective care. However, practices have varied approaches to delivering care and no HaH-specific national standards exist. We aimed to develop national practice standards for HaH and assess practice performance against the standards. Methods: The HaH Users Group (HaHUG), the national convener of HaH practices, assembled the Practice Standards Council in 2019 to develop evidence-based standards for HaH. We reviewed existing international standards and the requirements of the Centers for Medicare and Medicaid Services Acute Hospital Care at Home Waiver. We engaged in multiple iterative rounds to develop domains and standards within each domain and then held an open comment period. We distributed an online survey for all HaHUG practices to self-assess whether they did not meet (score, -1), met (score, 0), or exceeded (score, +1) each standard. The American Hospital Association's Annual Survey was used to describe practices that did and did not complete the practice standards survey. Results: Final practice standards included 31 standards in 7 domains: leadership; education and training; human resources management; quality and quality improvement; safe practice and environment; and clinical standards and protocols. The majority of HaH practices self-rated that they met or exceeded standards: scores ranged from -5 to 31; mean score of 9.75 (SD, 12.60). Forty-nine of 213 eligible HaH practices completed the survey (response rate, 23.0%). Most hospitals were large (65% > 299 beds), nonprofit (85%), teaching (90%) centers that cared for a large proportion of patients with Medicaid. Conclusion: We present the first national practice standards for HaH. The vast majority of HaH practices met or exceeded these standards by their own assessment. There was a range of performance across standards, demonstrating strengths and opportunities for ongoing development and quality improvement.