Table 2

Domains, subdomains and illustrative examples of summative patient and clinician mock admission experience

DomainSubdomainIllustrative example
Comfort level during rural home hospital admissionPatient and caregiver perspectivePatient: “[When y]ou have to go to the hospital, it’s such a big hassle.”
Caregiver: “And you sit there and sit there. Well, [with home hospital] …you're at home where you feel comfortable.”
Patient: “Yeah. I get a phone call this morning saying, ‘We're on our way.’ You might be waiting, but at least you're waiting at home, right?” (1a)
Clinician perspectivePhysician: “[T]he only part that made me nervous with the admission or I think has the potential to make me nervous with other admissions like this is just that initial diagnostic uncertainty…[A]s long as we're sure about the diagnosis then I felt really comfortable moving forward… It’s just that initial, ‘Is this heart failure or is this COPD?’ [S]omething that could help with that in real life would be if the patient’s cardiologist called me and said, ‘I know this patient really well. They always have heart-failure exacerbations. If they have symptoms, they're having another exacerbation, can we do the Home Hospital?” [T]hen I would feel more confident, or if the patient initially went to the ER and had some diagnostic work-up and then I had that data, then they could start the admission, that’s something that'd make me feel more comfortable too. [When you’re diagnostically uncertain], you just need to physically be there and put your hands on the patient and listen yourself.” (2a)
Perceived safety during rural home hospital admissionPatient and caregiver perspectivePatient: “There have been times when I knew I had to be in the hospital because I couldn’t breathe at all, and I needed the doctor. And the doctor said, ‘You waited too long,’ because I had waited until I was really bad sick before I went to hospital.” (3b)
Clinician perspectivePhysician: “I'm… used to in the hospital… having a pharmacist verify med[ication]s, and a lot of times they come up with crazy discrepancies that I don't even know about.” (4b)
Perceptions of rural home hospital workflowInefficient processesPhysician: “ I think [the in-home clinician] was very well-meaning in asking a lot of his questions, but I felt like he tried to sort of do his own H&P and then called me, and I felt like it could have duplicated things and the patients felt like they were repeating stuff.” (5c)
Efficient processesPatient: “I think today I had good care. I really do… For what I had, I would've had to have sat in the waiting room unless I was really having a heart attack…I think that’s rule number one. Make sure they sit in the waiting room for at least two hours…I thoroughly like this idea right here.” (6d)
In-home clinician: “I am just not used to having a physician spending as much time with a patient as we have here. If that’s this model, it’s a win-win. [I]f a physician can actually dedicate 15 minutes to a patient every day…, what a cherished thing.” (7d)
Team collaborationPhysician: “I think something that’s a benefit of the Home Hospital is that [the in-home clinician] would be there… [to lay] out the patient’s medicines for them.” (8e)
TechnologyPhysician: “[Similar to TeleStroke systems,] the doctor having control of that camera might be kind of cool, and then just working on the resolution so I could feel a little bit more confident about my physical exam.” (9f)