Background: The Department of Veterans Affairs (VA's) Hospital In Home (HIH) program, designed from experiences of the Hospital At Home community program, is a model of care that delivers patient-centered, acute-level hospital care at home which has demonstrated safety, effectiveness and patient satisfaction beyond those observed in hospitals. Since 2010, the VHA Office of Geriatrics & Extended Care (GEC), through its transformational programs and mentored partnerships has spurred the development of [12] HIH program sites nationally, which have all been sustained by their parent station. Significance/Impact: [Hospital In Home is a mix of interventions and levels of implementations; understanding how to weave these successfully is the overarching aim of this project.] Continued spread of HIH across the VA requires evidence be established regarding the need for HIH and about the implementation of existing HIH programs. Understanding barriers and facilitators and processes of implementation of HIH programs will allow more facile adoption of HIH programs allowing for substantial cost savings of about $3,000 per inpatient event. Especially in the era of the Mission Act, having HIH available may incentivize Veterans to choose VA. [With the recent Covid-19 pandemic, HIH has been identified as a potential contributor to addressing the disease and sequelae.] Innovation: This project will generate generalizable knowledge regarding implementation of HIH models and will advance implementation science from its application of implementation science frameworks, Re-Aim- PRISM and novel methods such as Implementation Mapping. The project will curate knowledge garnered from the existing programs and develop tools to disseminate it. It will develop and conduct readiness for implementation surveys. Finally, it will “dry-run” implementations in sites with greater readiness for implementation. The results of the “dry runs” will provide feedback to the implementation planning thus increasing their probability of successful adoption of HIH and its sustainment and growth. Specific Aims: 1. Establish evidence regarding the implementation of the existing HIH sites using a mixed methods approach. Deliverables: An evaluation framework and report summarizing the experiences of the existing sites. 2. Develop operational implementation tools and a readiness for implementation survey to be conducted. Deliverables: A survey of readiness for implementation and prioritization of sites ready to implement; implementation tools. 3. Select ten new sites with the greatest evidence of readiness for implementation to conduct “dry-runs” and create blueprints for implementation; identify causal loop diagram(s); catalog the evidence. Deliverables: Report summarizing common and site specific implementation themes; Site-specific Implementation logic models; Searchable catalog of HIH implementation strategies. Methodology: This mixed-methods project will conduct quantitative analyses, interviews, focus groups and “dry runs” applying implementation science frameworks and methods (RE-AIM-PRISM, implementation mapping) and system science to understand the existing HIH programs and to create implementation tools, evaluation framework, readiness survey, causal loop diagrams and a searchable catalog of HIH implementation evidence. Implementation/Next Steps: Future work will develop simulation studies and conduct evaluations of newly implemented sites as well as a hybrid II implementation trial of the effectiveness and safety of the HIH model.

Hospital In Home [HIH] is a model of care that delivers patient-centered, acute-level hospital care at home which has demonstrated safety, effectiveness and patient satisfaction beyond those observed in hospitals. Currently there are [twelve] HIH sites across the VA that are sustained by their stations; understanding how to weave the implementation experiences of these programs successfully is the overarching aim of this project. The project will evaluate the existing sites and develop implementation tools and strategies based on their experience. A readiness for implementation survey will be used to identify ten additional sites for implementation. It will then “dry run” the processes of implementation in these sites, further identifying implementation strategies and resulting in blueprints for implementation.