Roy J M Claessen, Annelies E van Ede, Merel van Gils, Rob P B Reuzel, Tamara E T van Woezik, Petra J M van Gurp
Co-learning and co-teaching in a newly introduced research learning community
The clinical teacher
worldwide increasing demand hospital home alternative hospital admission although growing evidence base effectiveness costeffectiveness hospital home health service managers health professionals policy makers require evidence implement sustain services wider scale 1 identify appraise synthesise qualitative research evidence factors influence implementation admission avoidance hospital home early discharge hospital home perspective multiple stakeholders including policy makers health service managers health professionals patients patients caregivers 2 explore synthesis findings relate help explain findings cochrane intervention reviews admission avoidance hospital home early discharge hospital home services searched medline cinahl global index medicus scopus 17 november 2022 also applied reference checking citation searching identify additional studies searched studies language included qualitative studies mixedmethods studies qualitative data collection analysis methods examining implementation new existing hospital home services perspective different stakeholders two authors independently selected studies extracted study characteristics intervention components assessed methodological limitations using critical appraisal skills checklist casp assessed confidence findings using gradecerqual confidence evidence reviews qualitative research applied thematic synthesis synthesise data across studies identify factors may influence implementation hospital home 7535 records identified database searches one identified citation tracking included 52 qualitative studies exploring implementation hospital home services 31 early discharge 16 admission avoidance 5 combined services across 13 countries perspectives 662 servicelevel staff clinicians managers eight systemslevel staff commissioners insurers 900 patients 417 caregivers overall judged 40 studies minor methodological concerns judged 12 studies major concerns main concerns included data collection methods eg reporting topic guide data analysis methods eg insufficient data support findings reporting ethical approval following synthesis identified 12 findings graded high n 10 moderate n 2 confidence classified four themes 1 development stakeholder relationships systems prior implementation 2 processes resources skills required safe effective implementation 3 acceptability caregiver impacts 4 sustainability services implementing admission avoidance early discharge hospital home services requires early development policies stakeholder engagement efficient admission processes effective communication skilled workforce safely effectively implement personcentred hospital home achieve acceptance staff refer patients services ensure sustainability future research focus lowerincome country rural settings perspectives systemslevel stakeholders explore potential negative impact caregivers especially admission avoidance hospital home service may become increasingly utilised manage rising visits emergency departments