{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:12:33Z","timestamp":1790773953614,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T00:00:00Z","timestamp":1664928000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000909","name":"John A. Hartford Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000909","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Centers for Medicare &amp; Medicaid Services (CMS) announced the Acute Hospital Care at Home (AHCaH) waiver program in November 2020 to help expand hospital capacity to cope with the COVID\u201019 pandemic. The AHCaH waived the 24\/7 on\u2010site nursing requirement and enabled hospitals to obtain full hospital\u2010level diagnosis\u2010related group (DRG) reimbursement for providing Hospital\u2010at\u2010Home (HaH) care. This study sought to describe AHCaH implementation processes and strategies at the national level and identify challenges and facilitators to launching or adapting a HaH to meet waiver requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted semi\u2010structured interviews to explore barriers and facilitators of HaH implementation. The analysis was informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework. Interviews were audio recorded for transcription and thematic coding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>\n                      We interviewed a sample of clinical leaders (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u200918; clinical\/medical directors, operational and program managers) from 14 new and pre\u2010existing U.S. HaH programs diverse by size, urbanicity, and geography. Participants were enthusiastic about the AHCaH waiver. Participants described barriers and facilitators at planning and implementation stages within three overarching themes influencing waiver program implementation: 1) institutional value and assets; 2) program components, such as electronic health records, vendors, pharmacy, and patient monitoring; and 3) patient enrollment, including eligibility and geographic limits.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation of AHCaH waiver is a complex process that requires building components in compliance with the requirements to extend the hospital into the home, in coordination with internal and external partners. The study identified barriers that potential adopters and proponents should consider alongside the strategies that some organizations have found useful. Clarity regarding the waiver's future may expedite HaH model dissemination and ensure longevity of this valuable model of care delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18071","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T08:03:01Z","timestamp":1664956981000},"page":"245-258","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["A national qualitative study of Hospital\u2010at\u2010Home implementation under the\n                    <scp>CMS<\/scp>\n                    Acute Hospital Care at Home waiver"],"prefix":"10.1111","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1010-2257","authenticated-orcid":false,"given":"Ksenia","family":"Gorbenko","sequence":"first","affiliation":[{"name":"Population Health Science and Policy Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Institute for Health Care Delivery Science Mount Sinai Health System  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Baim\u2010Lance","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Department of Veteran Affairs James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7590-0316","authenticated-orcid":false,"given":"Emily","family":"Franzosa","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Department of Veteran Affairs James J. Peters VA Medical Center and Geriatric Research Education and Clinical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Wurtz","sequence":"additional","affiliation":[{"name":"Human Rights Institute University of Connecticut  Storrs Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Schiller","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybil","family":"Masse","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Internal Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Ornstein","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Federman","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4337-9896","authenticated-orcid":false,"given":"David M.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Internal Medicine and Primary Care Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Ariadne Labs  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda V.","family":"DeCherrie","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Leff","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Siu","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"Department of Veteran Affairs James J. 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