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Original research
Scoping and testing rural acute care at home: a simulation analysis
  1. David M Levine1,2,3,
  2. Meghna P Desai3,
  3. Joseph B Ross3,
  4. Natalie Como4,
  5. Steve Holley5
  1. 1 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2 Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Ariadne Labs, Boston, Massachusetts, USA
  4. 4 University of Utah Health, Salt Lake City, Utah, USA
  5. 5 Utah Valley University, Orem, Utah, USA
  1. Correspondence to Dr David M Levine, Brigham and Women's Hospital, Boston, Massachusetts, USA; dmlevine{at}bwh.harvard.edu

Abstract

Purpose Hospital-level care provided at home improves patient outcomes, yet nearly all programmes function in urban environments. It remains unknown whether rural home hospital care can be feasibly delivered.

Methods Based on prior stakeholder learning and detailed landscape analyses of various rural areas across the country, we re-engineered the workflows, personnel and technology needed to respond to many of the challenges of delivering acute care in rural homes. We performed a preliminary ‘mock admission’ in a simulation laboratory with actor feedback, followed by mock admissions in rural homes in Utah of chronically ill patients who feigned acute illness. We employed rapid cycle feedback from clinicians, patients and their caregivers and qualitative analysis of participant feedback.

Findings Following rapid cycle feedback in the simulation laboratory and rural homes, mock admission, daily rounds and discharge were successfully conducted. Technology performed to laboratory-determined specifications but presented challenges. Patients noted significant comfort with and preference for rural home hospital care, while clinicians also preferred the model with the caveat that proper patient selection was paramount. Patients and clinicians perceived rural home hospital as safe. Clinicians noted rural home hospital workflows were feasible after streamlining remote and in-home roles.

Conclusions Rural home hospital care is technically feasible, well-received and desired. It requires testing with acutely ill adults in rural settings.

  • delivery of health care
  • hospital medicine
  • health services research

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Footnotes

  • Twitter @davidlevinemd

  • Contributors DML, JBR, MPD: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content; and final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NC: the acquisition, analysis, or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content; and final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SH: the acquisition, analysis or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content; and final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by an Ariadne Labs Spark Grant, Boston, MA.

  • Competing interests DML receives funding from Biofourmis for an investigator-initiated artificial intelligence study on deterioration of home hospital patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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