{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:47:58Z","timestamp":1792079278779,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["5I01HX003277"],"award-info":[{"award-number":["5I01HX003277"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The VA Hospital in Home (HIH) model of care delivers acute\u2010level hospital care to Veterans at home across the country. We aim to examine the similarities and differences in the structure and implementation of existing HIH programs across sites to identify best practices that optimize resources, ensure high\u2010quality care, and enhance sustainability and scalability of the program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 6 out of 11 existing VA HIH programs reported on their program through structured presentations at Community\u2010of\u2010Practice meetings in 2022. Additional site\u2010level characteristics were retrieved from the VA Corporate Data Warehouse to describe context at each program and to identify HIH encounters, types of stays, and numbers of HIH patients for each site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All sites offered transfer (from hospital\u2010based inpatient service) and substitutive (from other than inpatient) HIH stays, though the proportion of patients for each varied (transfer patients ranging from 6% to 85%). Referral sources for substitutive stays varied across sites including Home\u2010Based Primary Care (HBPC) (67%), outpatient primary care (83%), specialty care clinics (67%), and emergency departments (83%). Each program had interdisciplinary teams, though composition and staff size varied (4\u20137 full\u2010time equivalent [FTE] RNs; 1.0\u20132.0 FTE physicians). Programs varied in the number of unique patients served per program (63\u2013146 unique HIH Veterans annually). Programs reported similar procedures in clinical evaluation, informed consent, and maintaining 24\/7 access to the HIH team. Outcome metrics tracked include readmission (67%), cost avoidance (50%), and length of stay (50%). Additionally, 50% of sites reported integrating ancillary services and introducing program adaptations during the COVID\u201019 pandemic period such as virtual follow\u2010up visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study identified similarities and differences across the existing HIH programs, adapting to local contexts while maintaining quality of care. These characteristics may reflect differences in population and site characteristics, patient needs, and program goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70737","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:54:25Z","timestamp":1790567665000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Local Adaptations of Hospital in Home: Variations in Structure and Implementation Across Six\n                    <scp>VA<\/scp>\n                    Programs"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1179-1115","authenticated-orcid":false,"given":"Akanksha","family":"Samant","sequence":"first","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungjae","family":"Park","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical 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":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center  Bronx New York USA"},{"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":"Orna","family":"Intrator","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center  Bronx New York USA"},{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"},{"name":"VA Geriatrics and Extended Care Data Analysis Center, James J. Peters VA Medical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2906-2232","authenticated-orcid":false,"given":"Jennifer L.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Transformative Health Systems Research to Improve Veteran Equity and Independence Center of Innovation (THRIVE COIN), VA Providence Healthcare System  Providence Rhode Island USA"},{"name":"Department of Health Services Policy and Practice, School of Public Health Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"D'Arcy","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center  Bronx New York USA"},{"name":"VA Geriatrics and Extended Care Data Analysis Center, James J. Peters VA Medical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Porooshat","family":"Dadgostar","sequence":"additional","affiliation":[{"name":"VA Geriatrics and Extended Care Data Analysis Center, James J. Peters VA Medical Center  Bronx New York USA"},{"name":"Department of Environmental Medicine and Public Health Sciences University of Rochester  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza Yousefi","family":"Nooraie","sequence":"additional","affiliation":[{"name":"Department of Environmental Medicine and Public Health Sciences University of Rochester  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0613-1987","authenticated-orcid":false,"given":"Shivani","family":"Jindal","sequence":"additional","affiliation":[{"name":"Veterans Health Administration, Office of Geriatrics and Extended Care  Washington DC USA"},{"name":"Cincinnati VA Medical Center, Medical Service  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayna","family":"Cooper","sequence":"additional","affiliation":[{"name":"Veterans Health Administration, Office of Geriatrics and Extended Care  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8051-9539","authenticated-orcid":false,"given":"Jessica","family":"Barth","sequence":"additional","affiliation":[{"name":"Transformative Health Systems Research to Improve Veteran Equity and Independence Center of Innovation (THRIVE COIN), VA Providence Healthcare System  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Judon","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center  Bronx New York USA"},{"name":"VA Geriatrics and Extended Care Data Analysis Center, James J. Peters VA Medical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlena H.","family":"Shin","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR), VA Boston Healthcare System  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Augustine","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center  Bronx New York USA"},{"name":"VA Geriatrics and Extended Care Data Analysis Center, James J. Peters VA Medical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Hung","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), James J. Peters VA Medical Center  Bronx New York USA"},{"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"}]}],"member":"311","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2006.00855.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010118\u20103\u2010199302010\u201000011"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1605501"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.1999.tb01592.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007491.pub2"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15782"},{"key":"e_1_2_9_8_1","unstructured":"\u201cAcute Hospital Care at Home Individual Waiver Only (Not a Blanket Waiver) \u201d Centers for Medicare & Medicaid Services accessed June 22 2021 https:\/\/qualitynet.cms.gov\/acute\u2010hospital\u2010care\u2010at\u2010home."},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010143\u201011\u2010200512060\u201000008"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621424.2023.2301413"},{"key":"e_1_2_9_11_1","volume-title":"VHA Directive 1144(1): Hospital in Home Program. 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