Substitutive acute care strategies for brick-and-mortar hospitalisation: a narrative review and conceptual framework

Background After the COVID-19 pandemic and ageing populations significantly strained hospital capacity, the case for building capacity to safely treat acutely ill patients in alternative settings has never been clearer. Hospital inpatient costs also account for one-third of US healthcare expenditures and continue to rise, while patients increasingly prefer receiving care at home. As studies continue to demonstrate the safety and effectiveness of managing certain acute medical conditions in settings outside the hospital, it is important to better understand the factors that facilitate this healthcare transformation. Methods Through a narrative review of the literature, we sought to identify critical factors in the development of substitutive management strategies to inpatient hospitalisation across various acute conditions. In a modified Delphi process, we identified and organised these factors into a unified conceptual framework to further enable healthcare delivery redesign and better align patient need with the setting of care. Results We identified 14 critical factors that enabled patients to be managed using substitutive acute care strategies. A conceptual framework was then generated based on the following schema: (1) qualifying acute condition(s); (2) substitutive care delivery setting(s); (3) technological capabilities; (4) payment model, regulations and liability; (5) patient, family and clinician experience of care and (6) identification of eligible patient population. Conclusion A comprehensive understanding of these critical factors and the application of this conceptual framework can further enable the development of successful, high-quality substitutive management strategies to inpatient hospitalisation.