Statement from the Board of Directors on HITH

Authorised for release by the Board of Directors

We note with some concern the conflation of the terms ‘Hospital in the Home’ with ‘virtual hospitals’ or ‘home hospitals’ in recent reports within Australian media, and the health sector more broadly. We believe that terminology such as ‘Hospital in the Home’ (HITH) and ‘Hospital at Home’ (HaH) most accurately represents the care delivered and the skills required to provide hospital-level inpatient bed substitution care at home. We

believe it is crucial that appropriate terminology for this model of care - ‘Hospital in the Home’ or ‘Hospital at Home’; is adopted moving forward.

Australia was an early adopter of the HITH model, providing care at home to patients since the 1990s with proven clinical and cost effectiveness. 1 The Hospital in the Home Society of Australasia is the leading independent body for HITH in Australia and New Zealand, and its membership of clinicians has played a pivotal role in advancing high-quality HITH care. In 2023, the HITH Society of Australasia released a position statement defining HITH to be "acute inpatient equivalent care, utilising highly skilled staff, hospital technologies, equipment, medication, and safety and quality standards, to deliver hospital-level care within a person's place of residence or preferred (non-hospital) treatment location."

This terminology confusion is a global one. The British Geriatrics Society in 2022 outlined the potential for ‘virtual wards’ to cause confusion amongst patients and healthcare providers, as it implies delivery of ‘remote’ or ‘online’ offerings, and is not representative of the multidisciplinary and patient-centred care delivered in

evidence-based approaches towards Hospital in the Home programmes. 2 Virtual hospitals and virtual wards have previously been used to describe utilisation of digital health technologies to support care of people at risk of hospitalisation, but not during an acute episode of care. This virtual care model was initially described in United Kingdom with a focus on use of remote monitoring technology and does not have a robust evidence base in comparison to Hospital at Home. In contrast, Hospital at Home programmes involve inpatient care to unwell patients within their homes; supported by remote monitoring technology where appropriate. 3

As such, use of the term ‘virtual hospital’ or 'home hospital', does not align with the bulk majority of existing Australasian services, the scientific literature, nor professional societies both nationally and globally. Our clinical colleagues who deliver hospital care at home across Australia and the many specialty physicians who either support or refer into these services would be best served by using an internationally recognised and commonly-used term that accurately reflects this model of care and is much clearer for patients and caregivers.

Media and publishers, industry, government and funders, are encouraged to contact or consult with the Society as the peak body of experts and with representatives from across Australasia.

For enquiries, please contact Dr James Pollard via email at president@hithsociety.org.au

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1 Med J Aust 2012 Nov 5;197(9):512-9. doi: 10.5694/mja12.10480.

2 Bringing hospital care home: Virtual Wards and Hospital at Home for older people

3 Joint Statement: 'Hospital at Home' not 'virtual wards'