Rural Perceptions of Acute Care at Home: A Qualitative Analysis

Purpose Hospital‐level care at home in urban areas delivers low‐cost, high‐quality care. Few have attempted to deliver home hospital care in a rural environment, where traditional hospitals are often less equipped to deliver high‐quality care. Little is known about rural clinicians’ and patients’ pe...

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Bibliographic Details
Published in:The Journal of rural health 2021-03, Vol.37 (2), p.353-361
Main Authors: Levine, David M., Desai, Meghna P., Ross, Joseph, Como, Natalie, Anne Gill, Emily
Format: Article
Language:English
Subjects:
Access
access to care
acute care at home
Acute services
Adaptation
Barriers
Clinical outcomes
Domains
Health care
Health services
Home health care
home hospital
Hospitalization
Hospitals
Human resources
Internet
Intervention
Interviews
Optimism
Patients
Perceptions
Physicians
Professional attitudes
Qualitative analysis
Qualitative research
Quality of care
Readmission
Rural areas
Rural communities
Rural environments
rural health
Rural health care
rural hospital
Rural housing
Rural poverty
Urban areas
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Summary:Purpose Hospital‐level care at home in urban areas delivers low‐cost, high‐quality care. Few have attempted to deliver home hospital care in a rural environment, where traditional hospitals are often less equipped to deliver high‐quality care. Little is known about rural clinicians’ and patients’ perceptions regarding rural home hospital care and how the urban model might be adapted to fit rural circumstances. Methods We conducted semistructured qualitative interviews in the United States with a national purposive sample of practicing rural clinicians, a focus group with clinicians who care for rural patients, and interviews with rural patients. We coded these qualitative data into domains and subdomains. Findings We identified 4 domains: (1) current state of rural health care, (2) attitudes toward rural home hospital, (3) perceived barriers to implementing rural home hospital, and (4) perceived facilitators to implementing rural home hospital. Participants expressed challenges with current rural health care, including inefficient care coupled with poor access. Most felt rural home hospital care could offer benefits, including comfort, timeliness, and downstream outcomes such as readmission rate reduction. Rural patients were open to receiving acute care in their homes. Potential barriers included geographic accessibility, Internet connectivity, rural hospital politics, the culture of hospitalization, and the availability of skilled human resources. Conclusions Significant interest and optimism exist surrounding rural home hospital despite perceived barriers. Designing for and testing adaptations to the urban model will likely optimize benefits and minimize threats to a potential intervention.
ISSN:0890-765X
1748-0361
DOI:10.1111/jrh.12551