METHODS article
Front. Health Serv.
Sec. Implementation Science
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1571090
Barriers and Facilitators to Scale-Up of Hospital-at-Home: an Observational Cohort Study Protocol
Provisionally accepted
- 1Department of Medicine, National University Hospital, Singapore, Singapore
- 2Behavioural and Implementation Science Interventions (BISI), National University of Singapore, Singapore, Singapore
- 3NUHS@Home, National University Health System (Singapore), Singapore, Singapore
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Introduction: Hospital-at-Home interventions have been shown to be clinically and cost-effective, and many healthcare systems internationally are investing in scaling-up such interventions. However, most existing studies focus on how effective the intervention is, rather than how to successfully scale it up. We report a study protocol for a theory-driven investigation of a Hospital-at-Home intervention. We propose a novel combination of two established implementation science frameworks -the EPIS framework and the Scale-Up framework -and apply it to a planned scale-up of a Hospital-at-Home intervention in Singapore.Methods and analysis: This will be an observational cohort study across 23 months (May 2022 to April 2024) to evaluate the association of outer and inner contextual factors on key implementation outcomes -the volume of patients admitted, operational efficiency and levels of adoption. Statistical process control graphs will be used to examine variation in the implementation outcomes over time. Linear regression will be applied to assess associations of outcomes with contextual factors that are continuous variables; logistic regression will be applied to assess the associations of outcomes with binary/descriptive contextual factors. To supplement these, qualitative methods will be applied using a content analysis of monthly meeting minutes and focus group discussions with the implementation team to understand and explain the outcomes of the observational cohort study.Ethics and dissemination: This protocol has been reviewed and approved by the National Health Group Domain Specific Review Board: Reference Number: 2023/00245. Apart from the end-ofstudy focus group discussions, waiver of informed consent was sought as the data sources were a review of routinely collected retrospective data. The results of this study will be disseminated to peer-reviewed journals, presented at conferences and shared with policy-level stakeholders.
Keywords: Hospital-at-home, Singapore, Barriers and facilitators, EPIS framework, Scale-Up Framework, Contextual influences
Received: 04 Feb 2025; Accepted: 19 May 2025.
Copyright: © 2025 Ko, Low and Sevdalis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Stephanie Q Ko, Department of Medicine, National University Hospital, Singapore, 119074, Singapore
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.