Guidance for Building <i>Hospital at Home</i>: Qualitative Descriptive Thematic Analysis of a Pan-Canadian Community Participatory Workshop Series.

Abstract

Virtual health care models, such as Hospital at Home (HaH), are an alternative to in-person care and allow hospitals to expand care capacity and delivery without the need for additional brick-and-mortar structures. While generally well received, there is an overall lack of awareness among those receiving and giving care about what HaH is and what it does, and uncertainty about the conditions needed to implement HaH in a safe, sustainable, and equitable way. In this descriptive qualitative study, we aimed to synthesize key interest holder-generated perspectives about the implementation, sustainability, and equity of HaH models in Canada using data generated through a national participatory workshop series. Health care providers, patients, caregivers, and hospital administrators were recruited to participate in the workshop series through social media, professional, and community networks. Five 60-minute virtual workshops were held from January to June 2025 using a "Lunch and Learn" format and Liberating Structures techniques. The workshops each comprised 2 parts: speaker presentations followed by participant group discussions. Workshop presentations, along with 3 written observer reports (from a patient partner, an academic, and a clinician), and workshop attendee polling responses, were collected and analyzed. Descriptive thematic analysis was used to construct key themes salient to the data. Three themes were constructed from the data: (1) making HaH work for health care systems, (2) making HaH work for its people, and (3) making HaH better now and in the future. Participants reported generally positive outcomes and high satisfaction with HaH programs in Canada. Participants highlighted the need for clear communication and collaboration across care teams, technology support for staff, managing health care provider and caregiver workloads, and ensuring access for rural and remote communities. There is a need to better understand the economic sustainability of the HaH program and to study and share outcomes from HaH models to help others and refine the model. This study provides insights into how the HaH virtual care model is perceived by health care providers, patients, caregivers, and hospital administrators in Canada. Our findings highlight the importance of equity, communication, care workloads, and fiscal sustainability in supporting HaH models.