Implementation determinants, strategies and outcomes for scale-up of hospital-at-home: a systematic review.

Authors

Stephanie Q Ko, Rachel H Choe, Yan Ling Lai, Nick Sevdalis

Published in

Implementation science communications. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

Hospital-at-Home (HaH) has been shown to be clinically and cost effective, but many programs struggle to scale. We conducted a systematic review of HaH studies reporting implementation contexts, strategies and outcomes with the primary aim to synthesise the implementation evidence on HaH. Our secondary aim was to develop a framework of HaH implementation outcome indicators for future studies to apply.
We searched the literature PubMed, Embase and Scopus, for publications from 2012 to 2022. We included studies related to HaH that included at least one implementation context and at least one implementation outcome variable, excluding clinical outcomes measures. At least two reviewers independently selected studies, abstracted data and assessed quality. We coded the implementation determinants to the Consolidated Framework for Implementation Research (CFIR); implementation strategies to the Expert Recommendations for Implementing Change (ERIC); and implementation outcomes to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) frameworks.
We included 27 studies in the final review, which reported 24 CFIR contextual factors, 25 ERIC strategies, and all domains of the RE-AIM evaluation framework. The most commonly reported implementation determinant, identified in six studies, was information technology infrastructure, which included streamlining documentation processes and improving access to patient records. Five studies described the following implementation factors: (i) work infrastructure, focusing on organising manpower effectively; (ii) capability of innovation deliverers, referring to staff posessing the necessary skills to perform their roles; and (iii) local conditions, such as the geographical challenges associated with HaH. The most frequently referenced implementation strategies were conducting ongoing training (nine studies), creating new clinical teams (eight studies), and promoting adaptability (seven studies). All assessed implementation outcomes were aligned to the RE-AIM framework, with volume of admissions, patient-reported experiences or outcome measures, and home visit frequency being most commonly reported (four studies each). The majority of implementation measures lacked a common denominator, and use of validated tools across studies was lacking.
We identified a list of implementation determinants, strategies and outcomes that can be used to inform scale-up of HaH, and have developed a framework for consistent reporting of HaH implementation studies grounded onto RE-AIM.

PMID:
42401961
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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