Family Perceptions of Pediatric Acute Hospital Care at Home in the United States: A Qualitative Analysis

Abstract

Objective: Acute hospital care at home has emerged as an alternative to conventional hospitalization with comparable, if not better, clinical outcomes and patient experience in adults and internationally. To date, no programs serve a pediatric population in the United States. We aimed to qualitatively assess the perceptions of patient caregivers toward pediatric home hospital (HH) to inform family-centered design and implementation.

Patients and methods: Semistructured interviews were performed with a purposive sample of family caregivers of children who were recently hospitalized at an urban freestanding children's hospital. Interviews focused on experiences with previous hospitalization along with perceptions of pediatric HH that emphasized potential benefits and challenges. Qualitative data were coded and analyzed using thematic analysis to construct core themes.

Results: Among 20 caregiver participants, we identified 3 central themes. Relative to inpatient hospitalization, which was associated with disruptions to family routine and psychosocial stressors among other challenges, (1) family caregivers were largely receptive to the HH concept and described numerous potential benefits, including improved physical comfort, patient behavior, and hospital capacity management; (2) concerns about caregiver burden, clinical monitoring and safety, and scalability to different geographies and household conditions were noted as barriers to HH implementation; and (3) participants emphasized the importance of pediatric expertise among HH clinicians.

Conclusions: HH was perceived to address many of the unintended consequences of conventional hospitalization with the potential to deliver more family-centered care. However, attention to unique clinical, psychosocial, and operational challenges are required to adapt existing models to the pediatric population in the United States.