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Table 4 Frequency of factors identified as facilitators or barriers to the implementation of the HBH model

From: Indicators of home-based hospitalization model and strategies for its implementation: a systematic review of reviews

Factor No. of systematic reviews and meta-analyses Example of quotes
No. of barriers No. of facilitators
1. Factors related to hospital at home (HBH) characteristics    
 1.1 Characteristics of innovation 2 3 Individual’s home situation, social support networks [55]. Nursing care which is only available for the last 2 weeks of life [24].
 1.2 Patient empowerment - 3 Patient and carer education for the recognition and management of acute exacerbation of chronic obstructive pulmonary disease [23]. Self-management education provided at home [49].
2. Individual factors: knowledge, attitude, and socio-demographic characteristics    
 2.1 Confidence in HBH developer or vendor 1 - Patients refused HBH due to lack of confidence and were admitted to hospital [52].
 2.2 Autonomy - 1 Differences were reported for patients’ preferred place of care, with each group of patients preferring care at home [51].
 2.3 Sociodemographic characteristics - 1 Strong evidence that patients aged 75 and over may be safely included in early supported discharge (ESD) and hospital at home (HAH) schemes. Most patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease are elderly [23].
3. External factors: human environment    
 3.1 Patient and health professional interaction 1 - Miscommunication in teaching the parents [50].
4. External factors: organizational environment
4.1 Internal environment
4.1.1 Characteristics of the structure of work
   4.1.1.1 Practice size - 1 Nursing care available for 24 h if required [25].
   4.1.1.2 Workforce issues (shortage, retention) 1 - Lack of access to 24-h care [25].
4.1.2 Nature of work    
   4.1.2.1 Work flexibility - 1 Evening and night cover was provided by a direct line to medical chest unit or provided by district nurses [26].
4.1.3 Skills (staff)
   4.1.3.1 Skill mix - 11 The service was co-ordinated by a nurse [12, 20, 22, 24,25,26, 52]; rehabilitation services were coordinated with social care [51]. Nurses with respiratory experience [12, 23] or experience in delivering HAH treatment [23].
   4.1.3.2 Multidisciplinary collaboration - 10 Nurse and medical team (including a physician) [53. Specialist and dedicated nurses, specialist physicians, social worker, dietitian, physiotherapist, occupational therapist (OT), speech therapist, and volunteers [22, 51]. Hospital outreach team, a mix of outreach and community staff, general practitioner, community nursing staff, physiotherapist, OT, social worker, counselor, speech therapist, cultural link worker [25, 52].
4.1.4 Resources
   4.1.4.1 Material resources (access to information and communication technology) - 3 Telephone support [23, 49], oxygen therapy, nebulised bronchodilators, intravenous antibiotics, and steroids [23].
Lab values and ECGs done at home, radiographs and echocardiograms at hospital [49].
   4.1.4.2 Human resources (information technology (IT) support, other) 1 1 Staff reported that the service was better staffed than usual after care services [51]. Nurses reported that additional help should have been provided for caregivers looking after the participants and for night nursing [24].