The experience of family caregivers when their loved one is home hospitalized: a mixed methods analysis of a randomized controlled trial
Ryan C L Brewster, Meghna Desai, Sarah Findeisen, Stephanie Blitzer, Michelle Grinman, Mitchell Wicker, Scott Harrison, Steven Amrhein, Mary Barthel, David M LevineAbstract
Background
Home hospital has been shown to achieve comparable, if not better, clinical and patient-centred outcomes compared to brick-and-mortar (BAM) hospitalisation. Family caregivers (FCs) play an essential role in delivering home hospital care; however, their perceptions towards the home hospital model remain an active area of inquiry, particularly in rural settings.
Methods
We conducted a mixed methods analysis of FCs of patients participating in a multicenter randomised controlled trial of rural home hospital in the USA and Canada. We compared pre- and post-intervention burden among home hospital and BAM caregivers with the Zarit Burden Interview-12 (ZBI-12) scale (n = 20 home hospital, n = 10 BAM). We conducted semi-structured qualitative interviews with home hospital caregivers (n = 19). Qualitative data were coded and analysed using thematic analysis to construct core themes and subthemes.
Results
There was no significant difference in median ZBI-12 scores between home hospital and BAM at admission (4 interquartile range [IQR 2–9.3] vs 5 [IQR 0.3–9.3]; P = .723), discharge (6 [3.3–8] vs 7.5 [2.5–11.8], P = .309), or change from admission to discharge (0 [−2.5 to 3] vs 1.5 [0–3.5]; P = .269). Our qualitative analysis revealed three central themes: (i) The caregiving experience was positively shaped by strong communication and shared decision-making with the care team; (ii) Caregivers described receiving high-quality home hospital care, particularly surrounding patient-centeredness and technology; and (iii) Home hospital was perceived to offer greater flexibility, comfort and psychosocial support compared to BAM hospitalisation.
Conclusion
Home hospital provides numerous benefits for FCs without increasing perceived burden; further work is needed to establish potential supports to optimise their experience.