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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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| Published in: | The Journal of rural health 2021-03, Vol.37 (2), p.353-361 |
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| Main Authors: | , , , , |
| Format: | Article |
| Language: | English |
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| cited_by | cdi_FETCH-LOGICAL-c3531-2282c40910be38179fbb5e466bae4418f023693a5ae65f1377998a40eb945383 |
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| cites | cdi_FETCH-LOGICAL-c3531-2282c40910be38179fbb5e466bae4418f023693a5ae65f1377998a40eb945383 |
| container_end_page | 361 |
| container_issue | 2 |
| container_start_page | 353 |
| container_title | The Journal of rural health |
| container_volume | 37 |
| creator | Levine, David M. Desai, Meghna P. Ross, Joseph Como, Natalie Anne Gill, Emily |
| description | 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. |
| doi_str_mv | 10.1111/jrh.12551 |
| format | article |
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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.</description><identifier>ISSN: 0890-765X</identifier><identifier>EISSN: 1748-0361</identifier><identifier>DOI: 10.1111/jrh.12551</identifier><identifier>PMID: 33438811</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>The Journal of rural health, 2021-03, Vol.37 (2), p.353-361</ispartof><rights>2021 National Rural Health Association</rights><rights>2021 National Rural Health Association.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3531-2282c40910be38179fbb5e466bae4418f023693a5ae65f1377998a40eb945383</citedby><cites>FETCH-LOGICAL-c3531-2282c40910be38179fbb5e466bae4418f023693a5ae65f1377998a40eb945383</cites><orcidid>0000-0002-1159-7979 ; 0000-0002-4337-9896</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,783,787,27878,27936,27937,31011</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33438811$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Levine, David M.</creatorcontrib><creatorcontrib>Desai, Meghna P.</creatorcontrib><creatorcontrib>Ross, Joseph</creatorcontrib><creatorcontrib>Como, Natalie</creatorcontrib><creatorcontrib>Anne Gill, Emily</creatorcontrib><title>Rural Perceptions of Acute Care at Home: A Qualitative Analysis</title><title>The Journal of rural health</title><addtitle>J Rural Health</addtitle><description>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.</description><subject>Access</subject><subject>access to care</subject><subject>acute care at home</subject><subject>Acute services</subject><subject>Adaptation</subject><subject>Barriers</subject><subject>Clinical outcomes</subject><subject>Domains</subject><subject>Health care</subject><subject>Health services</subject><subject>Home health care</subject><subject>home hospital</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Human resources</subject><subject>Internet</subject><subject>Intervention</subject><subject>Interviews</subject><subject>Optimism</subject><subject>Patients</subject><subject>Perceptions</subject><subject>Physicians</subject><subject>Professional attitudes</subject><subject>Qualitative analysis</subject><subject>Qualitative research</subject><subject>Quality of care</subject><subject>Readmission</subject><subject>Rural areas</subject><subject>Rural communities</subject><subject>Rural environments</subject><subject>rural health</subject><subject>Rural health care</subject><subject>rural hospital</subject><subject>Rural housing</subject><subject>Rural poverty</subject><subject>Urban areas</subject><issn>0890-765X</issn><issn>1748-0361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><recordid>eNp10M1Kw0AUBeBBFFurC19ABtzoInV-MzNuJBS1SkEtXbgLk3iDKUlTZxKlb-9oqgvBu7mbj8PhIHRMyZiGu1i61zFlUtIdNKRK6IjwmO6iIdGGRCqWzwN04P2SEGY0F_towLngWlM6RFfzztkKP4LLYd2WzcrjpsBJ3rWAJ9YBti2eNjVc4gQ_dbYqW9uW74CTla02vvSHaK-wlYej7R-hxc31YjKNZg-3d5NkFuVcchoxplkuiKEkA66pMkWWSRBxnFkQguqCMB4bbqWFWBaUK2WMtoJAZoTkmo_QWR-7ds1bB75N69LnUFV2BU3nUyaUkoxIzgI9_UOXTedC3aAkUVTR0CWo817lrvHeQZGuXVlbt0kpSb9GTcOo6feowZ5sE7ushpdf-bNiABc9-Cgr2PyflN7Pp33kJ3cZfPE</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Levine, David M.</creator><creator>Desai, Meghna P.</creator><creator>Ross, Joseph</creator><creator>Como, Natalie</creator><creator>Anne Gill, Emily</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T2</scope><scope>7TQ</scope><scope>C1K</scope><scope>DHY</scope><scope>DON</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1159-7979</orcidid><orcidid>https://orcid.org/0000-0002-4337-9896</orcidid></search><sort><creationdate>20210301</creationdate><title>Rural Perceptions of Acute Care at Home: A Qualitative Analysis</title><author>Levine, David M. ; Desai, Meghna P. ; Ross, Joseph ; Como, Natalie ; Anne Gill, Emily</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3531-2282c40910be38179fbb5e466bae4418f023693a5ae65f1377998a40eb945383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Access</topic><topic>access to care</topic><topic>acute care at home</topic><topic>Acute services</topic><topic>Adaptation</topic><topic>Barriers</topic><topic>Clinical outcomes</topic><topic>Domains</topic><topic>Health care</topic><topic>Health services</topic><topic>Home health care</topic><topic>home hospital</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Human resources</topic><topic>Internet</topic><topic>Intervention</topic><topic>Interviews</topic><topic>Optimism</topic><topic>Patients</topic><topic>Perceptions</topic><topic>Physicians</topic><topic>Professional attitudes</topic><topic>Qualitative analysis</topic><topic>Qualitative research</topic><topic>Quality of care</topic><topic>Readmission</topic><topic>Rural areas</topic><topic>Rural communities</topic><topic>Rural environments</topic><topic>rural health</topic><topic>Rural health care</topic><topic>rural hospital</topic><topic>Rural housing</topic><topic>Rural poverty</topic><topic>Urban areas</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Levine, David M.</creatorcontrib><creatorcontrib>Desai, Meghna P.</creatorcontrib><creatorcontrib>Ross, Joseph</creatorcontrib><creatorcontrib>Como, Natalie</creatorcontrib><creatorcontrib>Anne Gill, Emily</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>PAIS Index</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of rural health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Levine, David M.</au><au>Desai, Meghna P.</au><au>Ross, Joseph</au><au>Como, Natalie</au><au>Anne Gill, Emily</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rural Perceptions of Acute Care at Home: A Qualitative Analysis</atitle><jtitle>The Journal of rural health</jtitle><addtitle>J Rural Health</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>37</volume><issue>2</issue><spage>353</spage><epage>361</epage><pages>353-361</pages><issn>0890-765X</issn><eissn>1748-0361</eissn><abstract>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.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33438811</pmid><doi>10.1111/jrh.12551</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1159-7979</orcidid><orcidid>https://orcid.org/0000-0002-4337-9896</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0890-765X |
| ispartof | The Journal of rural health, 2021-03, Vol.37 (2), p.353-361 |
| issn | 0890-765X 1748-0361 |
| language | eng |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Wiley-Blackwell Read & Publish Collection; PAIS Index |
| 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 |
| title | Rural Perceptions of Acute Care at Home: A Qualitative Analysis |
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