Personalized Clinical Decision Support to Improve Participation in Hospital at Home

Hospital at Home (HaH) is an alternative to costly and high-risk inpatient hospitalization, where care teams provide acute, hospital-level care in a patient’s home. This alternative care model has been shown to improve patient-centered outcomes; however, barriers have limited its widespread adoption and impact. Barriers to HaH adoption include a lack of understanding about patient and caregiver preferences for acute care and the need for health information technology (IT)-enabled clinical decision support that integrates data from numerous sources to support point-of-care decision making.

To address this issue, researchers at Atrium Health will develop and evaluate the Partnering Patients and Providers for Personalized Acute Care Selection (4PACS), a shared decision making (SDM) tool that incorporates evidence-based risk modeling and patient and caregiver preferences for HaH.

The specific aims of the research are as follows:

• Characterize patient, caregiver, and provider perceptions of risk tradeoffs, needs, and care preferences for HaH.
• Design 4PACS iteratively with patients, caregivers, and providers to integrate risk-model probabilities and patient and caregiver preferences.
• Evaluate the feasibility of implementing 4PACS in acute care and establish the rate of patient and provider acceptance of HaH as a potential care option.

To achieve these aims, the research team will use a mixed-methods approach that leverages implementation science theory and user-centered design principles to address multilevel contextual factors within 4PACS development and enhance usability. Research methods include key informant interviews, surveys, a participatory design workshop, and iterative usability testing with patients, caregivers, and providers to assess whether 4PACS is acceptable, practical, and integrates well within existing systems. The research team will focus on adult patients hospitalized with pneumonia, a prevalent condition that is commonly examined in other HaH studies due to the substantial costs associated with acute care utilization.

This collaborative research will demonstrate the value of using health-IT enabled SDM tools that integrate clinical data with patient and caregiver preferences to highlight and overcome the barriers to implementing alternative care models, such as HaH, that have been shown to reduce healthcare costs and patient risk compared to traditional inpatient hospitalization.