Given the imbalance between high care demand and strained hospital capacity, hospital-at-home (HaH) models offer a potential solution by providing hospital-level care in patients’ homes. This scoping review maps the literature on hospital-led virtual health care within HaH models for acute infections, focusing on intervention characteristics and evaluation designs. Following Johanna Briggs Institute guidelines and PRISMA-ScR, we included studies on virtual and hybrid HaH models using telemedicine for remote monitoring and interventions. The literature searches were performed from October 3, 2022 to October 22, 2022, and updated on July 11, 2024 and identified 15,062 potentially relevant records. From these, 79 studies met the inclusion criteria, highlighting the diversity of HaH models and their evaluations. Hybrid models provided broader treatment options, but many studies lacked detailed intervention descriptions, complicating implementation and meta-analyses. Most studies evaluated patient outcomes, with limited attention to health care staff and relatives. Nearly 45,000 participants were assessed, but only 254 participated in randomized controlled trials, indicating a need for more high-level evidence. Relevant gaps remain, including model heterogeneity and inconsistent reporting.

The aim of the present study was to test an individualised dose without compromising the ease of analysing data when performing equilibrium radionuclide angiography (ERNA) using cadmium–zinc–telluride (CZT) SPECT. From March 2018 to January 2019, 1650 patients referred for ERNA received either an individualised dose of ^99mTc-labeled human serum albumin (HSA) according to their age, sex, height, and weight (n = 1567), or a standard dose of 550 MBq (n = 83). The target count rate (CR_T) was reduced every two months from 2.7 to 1.0 kcps. A final test with a CR_T of 1.7 kcps was run for three months to test whether an agreement within 2% points for the determination of LVEF, on the basis of only two analyses, was obtainable in at least 95% of acquisitions. All the included ERNAs were performed on a dedicated cardiac CZT SPECT camera. When using the algorithm for an individualised dose, we found that agreement between the measured and predicted count rate was 80%. With a CR_T of 1.7 kcps, the need for more than two analyses to obtain sufficient agreement for LVEF was 4.9%. Furthermore, this resulted in a mean dose reduction from 550 to 258 MBq. Patients’ weight, height, sex, and age can, therefore, be used for individualising a tracer dose while reducing the mean dose.

Introduction The combination of a reduction in the Danish hospital bed count, the shortage of hospital staff and demographic changes challenges the Danish hospital capacity. This was further highlighted during the COVID-19 pandemic when hospitals worldwide were overwhelmed by infected patients requiring acute hospital care. To address these challenges, a hospital-at-home (HaH) programme offers an alternative to conventional in-hospital admission. Furthermore, HaH has the potential to improve patient outcomes, reduce costs and increase patient satisfaction. However, few studies have evaluated HaH in a Scandinavian setting, and this article describes the protocol for a randomised controlled trial (RCT) comparing an HaH model with continued conventional in-hospital admission. The main aim of the trial is to evaluate physical activity level and mental wellbeing in patients admitted at home compared with conventionally admitted patients. Methods and analysis 110 clinically stable patients from two internal medical wards at Nordsjaellands Hospital in Denmark will be included and randomised in a ratio of 1:1 to either continued conventional in-hospital admission (control group) or virtual HaH model (intervention group). The control group will receive standard hospital treatment, and the intervention group will be transferred home for continued treatment (eg, intravenous antibiotics or oxygen treatment). The primary outcome measures are physical activity assessed using daily step count (during the first 24 hours after inclusion, as an intermediary indicator of the risk of adverse events) and treatment satisfaction (assessed using a patient satisfaction survey). Secondary outcome measures are adverse events of special interest, escalation of care, readmission rate postdischarge (30 days and 90 days), mortality (associated and 7 days, 30 days and 90 days postdischarge), process data (eg, the number of teleconsultations) and a health economic evaluation. Ethics and dissemination The study was approved by the Danish Research Ethics Committees (no. 2303051) and the Danish Medicines Agency (CIV-23-03-042542) and will be monitored by the Copenhagen University Hospital Good Clinical Practice unit. Results will be published in peer-reviewed journals and presented at relevant national and international conferences. We also plan to communicate the results to relevant stakeholders in the Danish healthcare system. Trial registration number NCT05920304.

Importance: Hospital-at-home (HaH) models may alleviate bed capacity constraints and reduce hospital-associated risks. Evidence on patient physical activity and patient experience in hybrid HaH for adults with acute conditions remains limited. Objective: To estimate whether a hybrid HaH model increases early physical activity and patient satisfaction without compromising safety or clinical outcomes compared with standard brick-and-mortar (BAM) care. Design, Setting, and Participants: This single-center, investigator-initiated nonblinded randomized clinical trial was conducted at 2 internal medical wards at a regional public hospital providing acute and emergency care in Denmark. Enrollment was from June 1, 2023, to January 31, 2025; follow-up continued to May 20, 2025. Adults (aged ≥18 years) admitted for acute illness were screened for eligibility. Key exclusions included unstable clinical condition, major physical or cognitive impairment, limited Danish proficiency, and pregnancy. Interventions: The hybrid HaH program (Influenzer) included remote patient monitoring via a patient-facing app and clinical dashboard with oversight 24 hours a day, 7 days a week; weekday virtual ward rounds; and home-based clinical tasks. BAM patients received standard inpatient care. Main Outcomes and Measures: Coprimary outcomes were physical activity during the first 24 hours after randomization and patient-reported satisfaction and perceived safety shortly after discharge. Secondary outcomes included mortality (7, 30, and 90 days), readmissions (30 and 90 days), and adverse events of special interest during admission. Results: Of 230 participants assessed for eligibility, 111 were randomized. The HaH model included 58 participants (median age, 64 [IQR, 50-75] years; 30 males [52%]); BAM included 53 participants (median age, 65 [IQR, 57-73] years; 28 males [53%]). HaH participants were significantly more physically active than BAM participants (adjusted mean difference, 1763 steps [95% CI, 153 to 3373 steps]; P = .03). Satisfaction was higher in HaH vs BAM (mean [SD] score, 4.41 [0.79] vs 4.10 [0.81]; mean difference, 0.31 [95% CI, −0.03 to 0.65]; P = .04), while perceived safety was similarly high across groups (mean [SD] score, HaH: 4.37 [0.88] vs BAM 4.23 [0.83]; mean difference, 0.14 [95% CI, −0.22 to 0.50]; P = .24). No significant differences were observed in any of the recorded safety events. Conclusions and Relevance: In this randomized clinical trial of adults receiving medical care for acute conditions at home, hybrid HaH was associated with greater early physical activity and patient satisfaction, with no signal of excess harm compared with BAM care. Future multicenter studies should incorporate frailty measures and assess durability and linkage to clinical end points. Trial Registration: ClinicalTrials.gov Identifier: NCT05920304

Hospital-at-Home (HaH) models deliver hospital-level care in patients’ homes, with some models relying on informal caregivers for support. While HaH