Increasing Hospital at Home Enrollment Through Decentralization with Agile Science

Abstract

The use of hospital at home (HaH) programs are rapidly increasing due to virtual capabilities, hospital capacities, and patient preferences. In 2020, a large hospital system instituted a multistate HaH program with a single command center. It is not known whether decentralizing command centers to local hospital sites increases patient enrollment in HaH programs. This article outlines how the Agile Implementation Process was applied to rapidly decentralize patient enrollment to a local hospital site and reports pre-post data on the number of patient enrollments per month, staff satisfaction, and qualitative quotes describing how the Agile Implementation process supported interprofessional staff engagement. In brief, 235 patients were included from the local site (pre: n = 105, post: n = 130) with a mean age of 70 years (SD 2.73), 55% male, and primarily Caucasian (99%). Postdecentralization, staff satisfaction increased by 63% (4.4-7.2) and the mean number of patients enrolled per month significantly increased from 15 to 22 (p =.01). An approximate 10% decrease in patient satisfaction was observed preintervention to postintervention (98.2-88.2%). In summary, the Agile Implementation quality improvement approach successfully decentralized patient enrollment to local hospital sites, increased patient enrollment, and staff satisfaction through staff engagement.Level of Evidence:4, Descriptive quality improvement project.