Hospital in the Home Australia: National HITH Research Published

We are pleased to share the publication of “A nationwide snapshot of Hospital in the Home service provision in Australia” in the Internal Medicine Journal.

This new Australian research provides a national picture of Hospital in the Home (HITH) and the delivery of hospital-level care at home across the country.

As health systems increasingly explore Hospital at Home, virtual care, home-based healthcare and alternatives to inpatient hospital care, understanding the existing Australian HITH landscape is increasingly important. Despite HITH having been part of the Australian healthcare system for more than 30 years, we have previously lacked a comprehensive national picture of where services are located, how they are structured, who works within them, and the types of care and technology they provide.

Thanks to an incredible response from the Australian HITH community, we now have a much clearer picture.

Thank you to the Australian HITH community

First and foremost, this research would not have been possible without the generosity of HITH clinicians, healthcare professionals, managers and services from across Australia who contributed their time and data.

Responses came from every Australian state and territory, with 84 survey responses representing 101 public hospital-affiliated HITH services. Overall, the study represented approximately 62% of the public hospitals identified as providing HITH care nationally.

We are particularly grateful to Hospital in the Home Society Australasia members who completed the survey, circulated it through their networks, encouraged colleagues to participate and helped us identify HITH services across the country.

The strength of the Society's national network was an important part of making this research possible.

What does Hospital in the Home look like across Australia?

One of the most important findings was just how established Hospital in the Home has become within the Australian hospital system.

Of the 643 public hospitals assessed nationally, 164 were identified as providing HITH care. HITH was available at 97% of principal referral hospitals, demonstrating how embedded the delivery of hospital care at home has become within Australia's major hospitals.

The study helped in creating the interactive map of HITH services locations on the HITH Society website

A diverse HITH workforce and different models of clinical governance

Nursing staff were present in 99% of services, while 84% reported having medical staff. Among services with senior medical staff, general physicians, geriatricians, infectious diseases physicians and general practitioners were all represented.

The study also identified considerable variation in clinical governance and medical responsibility. In 45% of services, patients were under the direct governance of HITH medical clinicians, while 32% used a hybrid model between HITH and referring teams and 23% retained governance with the referring team.

Understanding these differences will be important as Australia continues to develop the HITH medical workforce, clinical governance frameworks, education, training and accreditation needed to support the future growth of hospital care outside traditional hospital walls.

Technology, digital health and remote patient monitoring

Technology provided another interesting snapshot of the evolution of Hospital in the Home and virtual care in Australia.

87% of HITH services reported access to negative pressure wound therapy, 82% to elastomeric infusion pumps and 64% to point-of-care pathology testing at the patient's residence.

Video telehealth was available in 69% of services, while only 32% reported remote patient monitoring.

These findings demonstrate the significant clinical capability already available within Australian HITH while also highlighting opportunities for further development in digital health, remote monitoring, virtual wards and technology-enabled care at home.

Importantly, technology is only one part of Hospital in the Home. At its core, HITH remains about providing hospital-level care centred around the needs of the patient, supported by appropriate clinical governance, skilled healthcare professionals and the ability to recognise and respond to clinical deterioration.

The future of Hospital in the Home in Australia

Perhaps the most important message from this national study is that Australian HITH is both mature and diverse.

There is an established national workforce delivering increasingly complex hospital-level care in patients' homes, reducing reliance on traditional inpatient hospital beds while providing patients with an alternative place to receive acute hospital care.

At the same time, substantial differences remain between HITH services in workforce, governance, technology and models of care.

Having national HITH data provides an important foundation for benchmarking, healthcare service improvement, workforce development, clinical education, research and health policy. It can also support work to improve equitable access to HITH across metropolitan, regional, rural and remote Australia.

As healthcare systems increasingly look towards Hospital at Home, virtual hospitals and home-based models of acute care, Australia has an opportunity to build on more than three decades of HITH experience.

Most importantly, this paper belongs to the broader Australian HITH community. It is a national snapshot created through the experiences and contributions of services across the country.

Thank you again to everyone who contributed to making this research possible.

The full research article, “A nationwide snapshot of Hospital in the Home service provision in Australia” is now published in the Internal Medicine Journal.

If you have questions about the study, would like to know more about the findings, or are interested in using the research to inform your HITH service, healthcare planning or future research, please contact Iftah Amith at iftah.amith@hithsociety.org.au.