Identifying Potential Populations for Home Hospitalisation: A scoping review of the literature to support the review of the South Australian My Home Hospital service

Home hospitalisation services provide acute and sub-acute care for a patient in their own residence for conditions that would normally require admission to a traditional hospital. Such services can substitute traditional inpatient admission, utilising specialised technologies, skills, and supports.

My Home Hospital (MyHH) is an SA Health service delivered by a contracted service provider. The existing target populations of the MyHH service consist of twelve (12) different three-character Adjacent Diagnosis Related Groups (ADRGs), each of which can comprise up to four different four-character DRGs that represent different levels of patient complexity within that set.

To support the review and continual improvement of the MyHH in South Australia, the Flinders Health and Medical Research Institute (FHMRI) were commissioned by Wellbeing SA to conduct a scoping review of the recent literature since 2017, to identify novel populations for whom HITH services have been provided elsewhere, and who may represent people within South Australia who may also benefit from MyHH access into the future.

Observational studies and trialled models from the international and Australian literature are presented in this report, to firstly chart out the different targeted populations, before then summarising the evidence and providing insights for future extensions of the service, and diversification of home hospitalisation in South Australia.

Drawing upon the activity observed within Australia – three ADRGs are proposed as ‘High Proportion Services’ which are not currently within the scope of the MyHH, including septic arthritis; digestive malignancy; and infective endocarditis. Potential additionally relevant ‘High Volume Services’ were seen in digestive malignancy; miscellaneous musculoskeletal procedures for infection or inflammation of bone and joint; sleep apnoea; and septicaemia. ‘Other Targets’ from the Australian activity worth noting were also those for other digestive system disorders and septicaemia.

The trialled models that emerged, having also not been observed within the present national activity data, included those for dehydration and electrolyte imbalances; falls, frailty, and functional decline; delirium; and asthma exacerbation.

While beyond the current targets of the configuration of the MyHH service in SA, the review also highlighted future diversification considerations in post-surgery early supported discharge; children’s services; palliative care; mental health; and rural and remote services.

The insights provided here are based on observed HITH activity across Australia and the development of novel service delivery models, published within the international literature. To prioritise between these options, further local evidence can be used to profile the expected costs and effects of different options, relative to each other.