{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:54:06Z","timestamp":1787162046025,"version":"build-2736575974"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hospital-at-home (HaH) may help address rising healthcare demands in ageing populations by providing hospital-level care outside the hospital. In the Netherlands, an integrated care pathway (ICP) \u2018The Hague Respiratory Tract Infection Care Bridge\u2019, was developed for adults aged \u226565\u00a0years with moderate-to-severe lower respiratory tract infections, offering care through HaH, hospital-at-nursing-home (HaNH) or hospital admission. This study explored experiences with this ICP among the different care settings from the perspectives of patients, informal caregivers and general practitioners (GPs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Semi-structured interviews were conducted with participants across the 3 pathways, including 34 patients, 33 informal caregivers and 7 HaH GPs. Data were analysed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes emerged from patient and informal caregiver interviews: matching care to needs, shared decision-making and communication, and organisational collaboration. HaH and HaNH were generally seen as positive alternatives to hospitalisation, although feasibility depended on patients\u2019 and caregivers\u2019 physical and emotional circumstances. Overall satisfaction with care was high. Two themes were identified from GP interviews: practical feasibility and engagement in the HaH-pathway. Overall, GPs supported out-of-hospital treatments, but faced barriers regarding unclear responsibilities, minimal involvement in triage and fragmented communication across providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delivering hospital-level care outside the hospital for older adults requires context-sensitive, individualised approaches that align with patients\u2019 and informal caregivers\u2019 circumstances. Perceived safety and acceptability depended on this alignment and on effective organisational collaboration. Sustainable integration of HaH in GP practice requires clear communication pathways and greater involvement in decision-making. These findings provide practical guidance for implementing HaH and HaNH in acute care for older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag144","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:51:56Z","timestamp":1783597916000},"source":"Crossref","is-referenced-by-count":1,"title":["Hospital-at-home and beyond: experiences of patients, caregivers and general practitioners with out-of-hospital care for moderate-to-severe lower respiratory tract infections in older adults\u2014a qualitative study"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4120-327X","authenticated-orcid":false,"given":"Rianne M C","family":"Pepping","sequence":"first","affiliation":[{"name":"Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center , Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC ,","place":["The Netherlands"]},{"name":"Internal Medicine, Haga Hospital , Den Haag, Zuid-Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isis","family":"Vink","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center , Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Roos","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center , Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC ,","place":["The Netherlands"]},{"name":"Internal Medicine, Haga Hospital , Den Haag, Zuid-Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten O","family":"van Aken","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center , Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC ,","place":["The Netherlands"]},{"name":"Internal Medicine, Haga Hospital , Den Haag, Zuid-Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederiek","family":"van den Bos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden Universitair Medisch Centrum , Leiden, Zuid Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerrit-Dirk","family":"de Loor","sequence":"additional","affiliation":[{"name":"Florence , Den Haag, Zuid-Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke","family":"Borgdorff","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden Universitair Medisch Centrum , Leiden, Zuid Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimke C","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center , Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0734-0844","authenticated-orcid":false,"given":"Cees","family":"van Nieuwkoop","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care; Health Campus The Hague, Leiden University Medical Center , Hippocratespad 21 Building 3, Sixth Floor, Leiden 2300 RC ,","place":["The Netherlands"]},{"name":"Internal Medicine, Haga Hospital , Den Haag, Zuid-Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"2026071206363807500_ref1","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/S1473-3099(24)00176-2","article-title":"Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990\u20132021: a systematic analysis from the Global Burden of Disease Study 2021","volume":"24","author":"Bender","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"2026071206363807500_ref2","doi-asserted-by":"publisher","first-page":"Itc49","DOI":"10.7326\/AITC202204190","article-title":"Community-acquired pneumonia","volume":"175","author":"Rothberg","year":"2022","journal-title":"Ann Intern Med"},{"key":"2026071206363807500_ref3","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1001\/jamainternmed.2024.0077","article-title":"Inappropriate diagnosis of pneumonia among hospitalized adults","volume":"184","author":"Gupta","year":"2024","journal-title":"JAMA Intern Med"},{"key":"2026071206363807500_ref4","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1016\/j.chest.2022.11.006","article-title":"Hospital-level care at home for patients with acute respiratory disease: a descriptive analysis","volume":"163","author":"Hernandez","year":"2023","journal-title":"Chest"},{"key":"2026071206363807500_ref5","doi-asserted-by":"publisher","first-page":"S570","DOI":"10.1093\/infdis\/jiz053","article-title":"Global and regional burden of hospital admissions for pneumonia in older adults: a systematic review and meta-analysis","volume":"222","author":"Shi","year":"2020","journal-title":"J Infect Dis"},{"key":"2026071206363807500_ref6","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1155\/2007\/451417","article-title":"Admission is not always necessary for patients with community-acquired pneumonia in risk classes IV and V diagnosed in the emergency room","volume":"14","author":"Marrie","year":"2007","journal-title":"Can Respir J"},{"key":"2026071206363807500_ref7","doi-asserted-by":"publisher","first-page":"afaf033","DOI":"10.1093\/ageing\/afaf033","article-title":"Supporting older people through Hospital at Home care: a systematic review of patient, carer and healthcare professionals\u2019 perspectives","volume":"54","author":"Wong","year":"2025","journal-title":"Age Ageing"},{"key":"2026071206363807500_ref8","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1111\/jocn.16906","article-title":"Patients\u2019 and caregivers\u2019 perceptions of the quality of hospital-at-home service: a scoping review","volume":"33","author":"Wang","year":"2024","journal-title":"J Clin Nurs"},{"key":"2026071206363807500_ref9","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1093\/eurjcn\/zvaf025","article-title":"Exploring patient, informal caregiver, and nurse experiences with home-based hospital-level care for decompensated heart failure: a mixed-methods study","volume":"24","author":"Lubbers-Wolterink","year":"2025","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2026071206363807500_ref10","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1186\/s12916-024-03463-3","article-title":"Early discharge hospital at home as alternative to routine hospital care for older people: a systematic review and meta-analysis","volume":"22","author":"Lin","year":"2024","journal-title":"BMC Med"},{"key":"2026071206363807500_ref11","doi-asserted-by":"publisher","first-page":"e060490","DOI":"10.1136\/bmjopen-2021-060490","article-title":"Patients\u2019 experiences of being treated for acute illness at home as an alternative to hospital admission: a qualitative study in Denmark","volume":"12","author":"Bove","year":"2022","journal-title":"BMJ Open"},{"key":"2026071206363807500_ref12","article-title":"Van goede zorg verzekerd. Zinnige Zorg Screeningsrapport Systematische Analyse Infectieziekten","author":"Zorginstituut Nederland","year":"2019"},{"key":"2026071206363807500_ref13","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1111\/joim.13394","article-title":"Hospital at home for acute medical illness: the 21st century acute medical unit for a changing population","volume":"291","author":"Knight","year":"2022","journal-title":"J Intern Med"},{"key":"2026071206363807500_ref14","doi-asserted-by":"publisher","first-page":"798","DOI":"10.7326\/0003-4819-143-11-200512060-00008","article-title":"Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients","volume":"143","author":"Leff","year":"2005","journal-title":"Ann Intern Med"},{"key":"2026071206363807500_ref15","doi-asserted-by":"publisher","first-page":"77","DOI":"10.7326\/M19-0600","article-title":"Hospital-level care at home for acutely ill adults: a randomized controlled trial","volume":"172","author":"Levine","year":"2020","journal-title":"Ann Intern Med"},{"key":"2026071206363807500_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2020.103652","article-title":"The risk of overestimating cost savings from hospital-at-home schemes: a literature review","volume":"109","author":"Goossens","year":"2020","journal-title":"Int J Nurs Stud"},{"key":"2026071206363807500_ref17","doi-asserted-by":"publisher","first-page":"30","DOI":"10.5334\/ijic.6991","article-title":"Using design thinking for co-creating an integrated care pathway including hospital at home for older adults with an acute moderate-severe respiratory infection in the Netherlands","volume":"23","author":"Pepping","year":"2023","journal-title":"Int J Integr Care"},{"key":"2026071206363807500_ref18","doi-asserted-by":"publisher","first-page":"e073126","DOI":"10.1136\/bmjopen-2023-073126","article-title":"Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study","volume":"13","author":"Roos","year":"2023","journal-title":"BMJ Open"},{"key":"2026071206363807500_ref19","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1111\/jgs.15782","article-title":"Starting up a hospital at home program: facilitators and barriers to implementation","volume":"67","author":"Brody","year":"2019","journal-title":"J Am Geriatr Soc"},{"key":"2026071206363807500_ref20","volume-title":"Handboek kwalitatieve onderzoeksmethode","author":"Mortelmans","year":"2020","edition":"4th"},{"key":"2026071206363807500_ref21","volume-title":"Doing Research in the Real World","author":"Gray","year":"2022","edition":"5th"},{"key":"2026071206363807500_ref22","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"2026071206363807500_ref23","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"2026071206363807500_ref24","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s13012-016-0437-z","article-title":"A systematic review of the use of the consolidated framework for implementation research","volume":"11","author":"Kirk","year":"2016","journal-title":"Implement Sci"},{"key":"2026071206363807500_ref25","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s13012-020-01049-0","article-title":"Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes","volume":"15","author":"Sarkies","year":"2020","journal-title":"Implement Sci"},{"key":"2026071206363807500_ref26","doi-asserted-by":"publisher","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","year":"2015","journal-title":"BMJ"},{"key":"2026071206363807500_ref27","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009","journal-title":"Implement Sci"},{"key":"2026071206363807500_ref28","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1037\/qup0000196","article-title":"Conceptual and design thinking for thematic analysis","volume":"9","author":"Braun","year":"2022","journal-title":"Qual Psychol"},{"key":"2026071206363807500_ref29","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13012-025-01450-7","article-title":"The consolidated framework for implementation research (CFIR) user guide: a five-step guide for conducting implementation research using the framework","volume":"20","author":"Reardon","year":"2025","journal-title":"Implement Sci"},{"key":"2026071206363807500_ref30","doi-asserted-by":"publisher","first-page":"e0325662","DOI":"10.1371\/journal.pone.0325662","article-title":"Hospital-at-home care in Singapore: a review of overseas protocols and guidelines to support implementation and policy redesign (systematic review)","volume":"20","author":"Goh","year":"2025","journal-title":"PloS One"},{"key":"2026071206363807500_ref31","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1186\/s12913-023-09531-3","article-title":"Family caregiver involvement and role in hospital at home for adults: the patients\u2019 and family caregivers\u2019 perspective\u2014a Norwegian qualitative study","volume":"23","author":"Karlsen","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2026071206363807500_ref32","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1111\/jan.16955","article-title":"When the home becomes the setting for hospital treatment: a qualitative study of relatives\u2019 experiences","volume":"82","author":"Bertelsen","year":"2025","journal-title":"J Adv Nurs"},{"key":"2026071206363807500_ref33","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s11606-021-07065-0","article-title":"Perceptions of hospital-at-home among stakeholders: a meta-synthesis","volume":"37","author":"Chua","year":"2022","journal-title":"J Gen Intern Med"},{"key":"2026071206363807500_ref34","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1186\/s12912-024-02511-w","article-title":"Lived experiences of older adults within an integrated hospital-at-home service: an interpretive phenomenological analysis","volume":"23","author":"Wang","year":"2024","journal-title":"BMC Nurs"},{"key":"2026071206363807500_ref35","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1080\/01621424.2015.1092908","article-title":"Identifying challenges associated with the care transition workflow from hospital to skilled home health care: perspectives of home health care agency providers","volume":"34","author":"Nasarwanji","year":"2015","journal-title":"Home Health Care Serv Q"},{"key":"2026071206363807500_ref36","doi-asserted-by":"publisher","first-page":"e13996","DOI":"10.1111\/hex.13996","article-title":"Engaging patients in designing a transmural allied health pathway: a qualitative exploration of hospital-to-home transitions","volume":"27","author":"van Grootel","year":"2024","journal-title":"Health Expect"},{"key":"2026071206363807500_ref37","first-page":"9","article-title":"Patient and carer satisfaction with \u2018hospital at home\u2019: quantitative and qualitative results from a randomised controlled trial","volume":"52","author":"Wilson","year":"2002","journal-title":"Br J Gen Pract"},{"key":"2026071206363807500_ref38","volume-title":"General Practitioner More Often Female and Younger of Age [Huisarts vaker vrouw en gemiddeld jonger]","author":"Statistics Netherlands (Centraal Bureau voor de Statistiek)","year":"2020"},{"key":"2026071206363807500_ref39","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1111\/jocn.17758","article-title":"Continuity and coordination of care during hospital-to-home transitions: healthcare professionals' perspectives","volume":"35","author":"van Grootel","year":"2025","journal-title":"J Clin Nurs"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/7\/afag144\/68756653\/afag144.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/7\/afag144\/68756653\/afag144.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T22:44:36Z","timestamp":1783896276000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afag144\/8732200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":39,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afag144","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]},"article-number":"afag144"}}