Hospital Care at Home for Adults Living in Rural Settings: A Qualitative Evaluation

ABSTRACT

Purpose

Describe the perceptions of patients receiving rural home hospital (RHH) care.

Methods

This is a qualitative evaluation of a randomized controlled trial comparing RHH (intervention) versus brick‐and‐mortar (BAM) care (control) in three rural sites in the United States and Canada between February 23, 2022, and January 17, 2024. Participants include acutely ill patients who received RHH. RHH programs provided patients with twice‐daily nurse/paramedic visits, daily physician visits (remote), hospital‐level diagnostics and treatments in the home, and other care tailored to the patient. Patient experience while receiving RHH care analyzed thematically to identify advantages and disadvantages of this model of care in the rural setting.

Findings

We interviewed 38 of 79 RHH patients recruited to our randomized controlled trial. Mean age was 67 (SD 17), 100% were White, 29% female, 82% Medicare recipients, and 62% retired. Patient perceptions clustered around three main themes: (1) perceived quality of care; (2) perceived comfort; and (3) experience with technology. Overall, home hospitalized patients were satisfied with the care they received at home. This was driven by strong rapport with the care team and receiving safe and effective medical care in the comfort of their home. Patients noted perceived comfort from familiar home surroundings and improved social support, nutrition, and sleep. Patients felt technology facilitated their experience and noted it presented a learning curve and occasional barrier to care.

Conclusions

RHH patients reported positive patient experiences principally across perceived quality, comfort, and technology, with some opportunity for improvement in technology interfaces for select patients.

Trial Registration

NCT05256303

1. Introduction

Many rural North Americans experience significant health disparities. Patients in rural areas tend to have higher mortality rates and poorer overall health outcomes [1, 2]. Ongoing closures of rural hospitals due to consolidations further exacerbate long travel times for patients and caregivers [3, 4]. Home hospital (HH) models are emerging programs in the United States and Canada [5, 6, 7, 8, 9]. In this model, a patient receives care for their acute illness at home, instead of in the brick‐and‐mortar (BAM) hospital. HH typically includes daily in‐home and/or virtual visits from the care team, monitoring of vital signs, 24/7 in‐home response, and portable diagnostics.

There is little qualitative research examining the experience of rural home hospitalized patients and caregivers [10, 11], with a paucity of research for home hospitalized patients in rural communities [7, 9, 12]. Urban studies suggest that most participants reported an overall positive experience with HH, highlighting social support and preference for home over BAM [13, 14, 15].

To address this gap, we conducted the first multicenter randomized controlled trial (RCT) for rural home hospital (RHH) in the United States and Canada. The study's quantitative findings, including cost, utilization, and physical activity, were reported elsewhere [12]. It may be that patients in rural areas have different experiences than those already described in urban studies that may offer critical learnings on the successes and challenges of the RHH model. In this analysis, we evaluate patient qualitative data collected as part of our RCT to further understand the experience of home‐hospitalized patients in rural areas.

2. Methods

2.1. Setting and Design

We performed a multicenter RCT at two sites in the United States and one Canadian site between February 23, 2022, and January 17, 2024. Participants were randomized to RHH (intervention arm) or the BAM hospital ward (control arm). The study was approved by the institutional review board and was registered at clinicaltrials.gov. The two U.S. sites were approved by the institutional review board, and the one Canadian site was approved by a Human Research Ethics Board. All patients provided informed consent for qualitative interviews. We described the detailed methods of the study elsewhere [12].

2.2. Participants

Participants were recruited from three sites: Blessing Hospital (Quincy, Illinois, USA), Hazard Appalachian Regional Healthcare Medical Center (Hazard, Kentucky, USA), and Wetaskiwin Hospital and Care Centre (Wetaskiwin, Alberta, Canada). Adults with an acute illness requiring hospitalization and residence within the site's rural catchment area. Intervention patients completed a phone interview within 30 days after discharge and, after three attempts, were classified as lost to follow‐up.

2.3. Rural Designation

For the RHH RCT U.S. study sites, we used the Federal Office of Rural Health Policy (FORHP) at the Health Resources & Services Administration (HRSA) definition or “rural” based on 2010 U.S. census data [16]; all nonmetro counties (counties that are nonmetropolitan or micropolitan); all metro census tracts with RUCA codes 4–10 and; large area metro census tracts of at least 400 sq. miles in area with population density of 35 or less per sq. mile with RUCA codes 2–3. Healthcare providers who are in geographic areas that are defined as rural by the FORHP are eligible to apply for, or receive services from, HRSA rural health grants.

For the RHH RCT Canadian site Alberta Health Services (AHS), the following definition of “rural” based on the 2018 AHS/Alberta Health (AH) official standard geographic areas was used. Rural includes “Large Rural Centers and Surrounding Areas” as defined by the AHS/AH [17]: 10,000 to less than 25,000 population (Brooks, Canmore, Wetaskiwin, Camrose, Lloydminster, Cold Lake).

2.4. Intervention

The intervention group received care through RHH, while the control group received usual inpatient care in the BAM hospital. Full details of the intervention are described elsewhere [12].

2.5. Qualitative Interviews and Analysis

We developed a semi‐structured interview guide informed by the study team's prior clinical and research experience with HH (Appendix). Interviews explored topics related to patient experience, comfort, safety, technology use, and the care team.

All interviews were conducted and audio‐recorded for all three sites between February 23, 2022 and January 17, 2024 and transcribed verbatim with a HIPAA‐compliant service (TranscribeMe). We asked all intervention patients who enrolled in the study to be interviewed; no control patients were interviewed. Transcripts were coded using Dedoose qualitative software. A multidisciplinary research team with HH and qualitative research experience conducted a thematic analysis [18, 19]. An initial codebook was developed deductively based on the study's aims and interview questions. During coding of transcripts, additional subcodes were added iteratively to capture concepts that emerged from participants’ responses. Following coding, related codes were organized into subthemes, which were synthesized and organized into overarching themes that represented recurring patterns across participants. One member of the study team (MPD; female; MPH) coded all transcripts and a second coder (SF; female; BA) independently double‐coded a subset of interviews to assess consistency and refine the coding framework. Any inconsistencies were discussed between the two coders and resolved by consensus.

3. Results

Of the 79 intervention patients, 38 completed an interview (Table 1). The other 41 intervention patients not interviewed either declined to be interviewed or were lost to follow‐up after three attempted phone contacts. The mean age of those interviewed was 67 (SD 17), 100% were White, 29% female, 82% Medicare recipients, and 62% retired. Patient‐reported survey scores were similar between the two groups. Characteristics of interviewed and noninterviewed intervention patients are presented in Table 1. The interviewers completed 38 qualitative interviews across our three study sites over a period of 2 years. From qualitative analysis of interviews, we identified three overarching themes, each comprising multiple subthemes: (1) perceived quality of care; (2) perceived comfort; and (3) experience with technology.

TABLE 1.

Baseline patient characteristics (intervention only) ^a .

Characteristic	Interviewed (n = 38)	Not interviewed (n = 41)
Age, mean (SD) yrs.	67.24 (16.79)	61.68 (17.39)
Sex
Female	27 (71.05)	25 (60.98)
Male	11 (28.95)	16 (39.02)
Race/ethnicity
Asian	0	1 (2.44)
Black	0	1 (2.44)
White	38 (100.0)	39 (95.12)
Partner status
Divorced	4 (10.53)	9 (21.95)
Married/life‐partner	18 (47.37)	20 (48.78)
Other	1 (2.63)	0
Single	4 (10.53)	8 (19.51)
Widowed	11 (28.95)	4 (9.76)
Lives alone b	8 (21.05)	12 (30.00)
Home health aide b	1 (2.63)	2 (5.00)
Primary language
English	38 (100.0)	41 (100.0)
Health insurance c
Medicaid	6 (15.79)	11 (26.83)
Medicare	26 (68.42)	22 (53.66)
Medicare and Medicaid	5 (13.16)	6 (14.63)
Private	1 (2.63)	2 (4.88)
Education b
Completed some high school	7 (18.42)	9 (22.50)
High school	18 (47.37)	19 (47.50)
Completed some college	3 (7.89)	6 (15.00)
Associate degree	4 (10.53)	5 (12.50)
Bachelors degree (4‐year)	5 (13.16)	1 (2.50)
Masters degree or higher	1 (2.63)	0
Employment
Employed	6 (15.79)	10 (24.39)
Unemployed	5 (13.16)	12 (29.27)
Retired	24 (63.16)	17 (41.46)
Other	3 (7.89)	2 (4.88)
Smoking status
Yes	9 (23.68)	19 (46.34)
No	27 (71.05)	19 (46.34)
Don't know	2 (5.26)	3 (7.32)
Diagnosis
Asthma	2 (5.26)	2 (4.88)
Cellulitis	6 (15.79)	4 (9.76)
Complicated UTI	4 (10.53)	4 (9.76)
COPD	8 (21.05)	7 (17.07)
Heart failure	5 (13.16)	6 (14.63)
Other d	−	1 (2.44)
Other infection	4 (10.53)	10 (24.39)
Pneumonia	9 (23.68)	7 (17.07)
Comorbid condition count at admission, mean (SD) e , f	4.16 (2.15)	3.70 (2.59)
PRISMA frailty score at admission, mean (SD) g , h	2.68 (1.65)	2.69 (1.64)
8‐Item Interview to Differentiate Aging and Dementia score at admission, mean (SD) i , j	1.16 (1.85)	1.59 (2.36)
PHQ‐2 score at admission, mean (SD) j , k	1.37 (1.53)	1.49 (1.67)
PROMIS emotional support score at admission (SD) f , l	57.77 (9.22)	59.25 (6.02)
Brief Health Literacy Screening Tool score at admission, mean (SD) f , m	16.08 (3.12)	15.50 (4.36)
EuroQol VAS score at admission, mean (SD) b , n	59.53 (22.46)	60.98 (20.96)
ADLs on admission at admission, mean (SD) o , p	5.56 (1.23)	5.50 (1.28)
IADLs on admission at admission, mean (SD) p , q	6.67 (2.34)	6.55 (2.17)
Full code status, yes r	34 (94.44)	38 (92.68)
Outpatient medications, mean (SD) s	6.40 (4.66)	7.37 (5.81)
Admitted to hospital in past 6 months b	14 (36.84)	19 (47.50)
Visited ED in past 6 months	20 (52.63)	30 (73.17)
Readmission risk score on discharge, mean (SD) t	4.00 (1.71)	3.56 (2.26)

Abbreviations: ADL, activity of daily living; COPD, chronic obstructive pulmonary disease; ED, emergency department; IADL, instrumental ADL; PHQ‐2, Patient Health Questionnaire 2; PRISMA, Program of Research to Integrate the Services for the Maintenance of Autonomy; PROMIS, Patient‐Reported Outcomes Measurement Information System; SD, standard deviation; UTI, urinary tract infection; VAS, visual analogue scale; yrs, years.

^a Values are numbers (percentages) unless otherwise indicated. Percentages may not sum to 100 due to rounding.

^b For one patient not interviewed, this data is missing.

^c Medicare counts include Canadian provincial insurance.

^d Includes an unknown diagnosis.

^e A count of the patient's chronic comorbid conditions, out of the 20 conditions considered chronic by the Health and Human Services Office of the Assistant Secretary of Health [20].

^f For one patient interviewed and one patient not interviewed, this data is missing.

^g Range, 0−7, where scores greater than 2 indicate frailty.

^h For one patient interviewed and two patients not interviewed, this data is missing.

ⁱ Range, 0−8, where scores greater than 1 indicate cognitive impairment.

^j For two patients not interviewed, this data is missing.

^k Range, 0−6, where scores greater than 2 indicate depression.

^l Range, 4−20, where scores greater than 17 indicate better‐than‐average emotional support.

^m Range, 4−20, where scores of 4−12 indicate limited health literacy, scores of 13−16 indicate marginal health literacy, and scores of 17−20 indicate adequate health literacy.

ⁿ Range, 0−100, where higher scores indicate better health.

^o Range, 0−6, where higher scores indicate more independence.

^p For two patients interviewed and one not interviewed, this data is missing.

^q Range, 0−8, where higher scores indicate more independence.

^r For two patients interviewed, this data is missing.

^s For three patients interviewed and three patients not interviewed, this data is missing.

^t Range, 0−13, where scores of 0−4 indicate low risk of 30‐day readmission, scores of 5−6 indicate intermediate risk of 30‐day readmission, and scores greater than 7 indicate a high risk of 30‐day readmission.

3.1. Perceived Quality of Care

3.1.1. Experience With the Care Team

All patients interviewed reported positive experiences with the RHH care team. Patients noted their strong interpersonal skills: “They [nurses] were so professional and so kind, and I think of them as friends now.” Patients appreciated the one‐on‐one time the clinical team spent with them in their home: “The nurse that came, I loved her…you have more of a one‐on‐one relationship with them. They have more time to spend with you…I didn't feel like I was having to wait because of all the other people they had to take care of and stuff. It was amazing.” One patient felt “more calm and relaxed” because the care team had more time to be one‐on‐one with them compared to in a hospital. Patients felt valued and expressed that the clinical team treated them with dignity in their own home (Table 2, 1a).

TABLE 2.

Illustrative quotes.

Perceived quality of care	Experience with care team	“The two of them [nurses]. You can feel that they don't do it for the money… They've got a big heart, and they care about their patients. They just didn't come out and rush through things and leave. If we had questions, they took their time answering the questions and everything for us. They was really excellent.” [1a]
	Receiving effective medical care in the home	“It [remote visits] actually worked out really well because you can be more comfortable in talking to [the physician] when you're at home than in [the physician's] office…you're kind of keeping on guard in the office.” [1b]
	Safety	“We had an electrical storm one night. The electricity went off for a little bit, and the monitors went off…they called right away [RHH care team] and wanted to know was everything okay. They called once to ask [if I was] okay, that respirations was a little rapid. So that gave me confidence in them and peace of mind that they were actually watching.” [1c]
Perceived comfort	Environmental comfort	“I was more comfortable in my home than I was at the hospital. I was more uncomfortable at home at the same time because I was like, ‘My home's not as clean’. Everyone has their own clean preference, and I knew that when I walked in, I hadn't been able to clean because I had been at work for almost two weeks straight.” [2a]
	Social support	“I loved being able to be home, and the care was immaculate. I couldn't have asked for better. I needed to be home because of my brother. Being in the hospital just wasn't an option for me…it was a lifesaver for me, and it was very effective.” [2b]
	Nutrition	“Being able to eat my own food…I am a dietician by profession. And I just had no appetite, and nothing appealed to me because I wasn't feeling well and to be in my own home and having my own caregiver, I was well hydrated and well fed, and small feedings of maybe a poached egg or a bowl of soup or something that was very simple, but that's all I really wanted. I didn't want anything more and that was positive.” [2c]
	Physical activity and sleep	“I was comfortable more comfortable than I would have been at the hospital… It's different being able to sleep in your own bed when you're sick…and not getting woke up 15 times a night to get blood work.” [2d]
Experience with technology	Positive	“[The paramedic] sat down with us and went through everything that he was going to do, showed us the computer system [referring to tablet]. And being both of us in our mid 80s, we aren't techie people… it was no problem whatsoever. It was excellent.” [3a]
	Negative	“When she [paramedic] explained it to me, I was like, ‘Well, that's easy enough’. I could've fumbled through if I wanted to… I was overwhelmed…because of everything that is going on in my life…not necessarily anything to do with that [technology]. So I think I just couldn't clear a space in my mind for it…so you just sort of give up.” [3b]

Since the care team was treating patients in their home, they also had a unique opportunity to ensure that the home environment was safe for the patient. RHH care team members ensured patient care encompassed bettering the patient's environment: “The EMT went around with my husband and checked that we had fire extinguishers that were up to date and that we had CO2 protection.” Another community paramedic noticed that a patient's smoke detector needed a new battery and replaced it: “[The paramedic] had noticed that… [the smoke detector] beeps…and found out that it wasn't working… It needed a new battery… he took the battery out of his own at home, and it was in his pocket, and he put it in mine before he left. And then he goes, ‘Can I take your garbage out for you?’ Wow.”

3.1.2. Receiving Effective Medical Care in the Home

Overall, home patients perceived that they received similar or better‐quality care in the home. One patient said they were “100% confident” with the care they received in the home: “I couldn't have been more comfortable. More so than if I'd been in the hospital. I felt more confident than if I'd been in the [hospital].” Another patient who previously had a bad experience with blood draws in the hospital, said that the same blood draw was a “much better experience than it was in the hospital.”

Most patients agreed that having a remote physician was effective: “The quality of my doctor…I think it was the same…the doctor was online, but I didn't have any issues where I thought the doctor needed to be right there with me doing something for me because that's what the nurse was there for, and I healed well.” Patients cited comfort and ease as benefits of telehealth visits (Table 2, 1b). One patient said that she was initially “nervous” with a remote physician and that the experience was “very different” but after a while she “couldn't tell the difference and it felt ‘just like you're sitting in the office’.”

During their interview, all patients were explicitly asked if they would recommend RHH to a family member or friend. Hundred percent of patients said they would recommend the program: “I thought the program was absolutely wonderful, and I have told everybody that I know about it.” One patient had heard about the program from a friend who had a positive experience: “I have told all my friends, so has my husband, what a wonderful experience this was, it's really interesting because my neighbor…she raved about it [HH] and [told us] what a wonderful experience it was…I'm going to phone the minister of health and the premier as well…. I'm going to send them a letter.”

3.1.3. Safety

Patients reported positive perceptions of safety. Patients cited the continuous vitals monitoring as a reason for feeling safe (Table 2, 1c) as well as physical distancing from other infectious patients. As one patient explained, “There [were] people coughing and it was very noisy [in the hospital ward] …It was very positive for me to come home and be in my own home.”

Although most participants felt safe at home, one patient expressed concern about the potential fall risk in their home, including rugs, plants, and furniture. This patient described feeling “afraid that [they were] going to fall” “didn't want to fall and hurt [their] elbow.”

3.2. Perceived Comfort

3.2.1. Environment Comfort

Patients cited the ease and familiarity of being at home and benefits of being home hospitalized: “I had clean clothes I could wash every day that I didn't get in the hospital at times…friends came over, just being at home, being with my cats, and being not hospitalized because you could tend to get kind of institutionalized when you're in a hospital if you've been there for a while… it was nice just to be at home and be myself.” One patient expressed that being at home “helps with recovery” and another liked being able to watch “TV on [their] own TV set.” One patient felt slightly embarrassed with how her home environment would be perceived by the care team (Table 2, 2a).

Being at home meant that patients could maintain their hobbies and activities that brought them joy. One patient said they were able to continue their guitar lessons: “I've learned a lot [from the teacher] on the internet… You wouldn't believe all that I've learned. I've got my computer right here on the table right in front of me, sitting here in my recliner. You can go on her website [guitar teacher] …I've learned all of them in her videos, if I sit here and pick with her [referring to fingerpicking on the guitar], I could pick with her all day long. I love it.”

3.2.2. Social Support

Patients appreciated the ability to be closer to loved ones: “I like the fact that I got to be in my own home while being treated. That way, I could have family/friends visit.” Patients were also able to maintain their responsibilities such as caring for a family member (Table 2, 2b) and caring for their children and pets: “I did like the hospital because…I have a 9‐year‐old. I have pets. So I wanted to be at home to take care of my home life because not being at home makes them feel weird.”

3.2.3. Nutrition

Some patients preferred and benefitted from being able to consume their own food at home (Table 2, 2c). One patient said they enjoyed being able to eat their “mom's cooking.” Another patient said that home‐cooked meals were “more convenient.” Another patient enjoyed the food delivery service utilized by the program but wished that there had been more meal options: “There's just not much to pick from…a lot of times, you might have to have the same thing. But I still like the idea that they brought it to me.”

One patient who was a single mother said she was worried about how she would cook dinner for her family while she was home hospitalized and felt that it could be an issue for other patient's that lived alone and had no assistance: “When I came home, I was like, ‘How am I going to go to the grocery store? How am I going to get anything for dinner? Well, I guess it's order out tonight, y'all…thankfully, it was only barely 24 h they had me [admitted to RHH], but it was still one of those like, ‘What if I was stuck under it [HH] for a week?’ What was I going to do for that whole week I was stuck at home, and I couldn't go do anything grocery store‐wise.” One patient preferred meals in the hospital: “I'd say for the meals…that was definitely more convenient being in the hospital.”

3.2.4. Physical Activity and Sleep

Patients cited the ability to get uninterrupted rest as a benefit to being home hospitalized (Table 2, 2d). One patient said that they “can't rest in the hospital” and another said how “nice it was to sleep in my own bed and not be disturbed,” as there were “no bells ringing or anything.” Being able to freely move around was noted as a positive of being at home: “I think being at home…you can get up and move and [when] you're in the hospital, you can't.”

3.3. Experience With Technology

3.3.1. Positive Perceptions of Technology

Many patients were comfortable with RHH technology. They said the technology seemed advanced, it improved access to healthcare, and made their visits more convenient: “I thought [the physician video visit] was great, you can take blood at home and find out the results right away.” One patient said their experience with the technology “was a lot better than [they] thought it would be,” and another older patient felt that the care team did a good job educating the patient on how to engage with the technology (Table 2, 3a).

3.3.2. Negative Perceptions of Technology

Several patients noted initial hesitation and frustration with the technology: “At first [the] [tablet] was kind of aggravating” and noted that it took some education and time to become familiar: “It was okay. It was all weird at first…it just took a minute to get used to.” One patient said they were too “overwhelmed” to engage properly with the technology and therefore not engaged enough to troubleshoot (Table 2, 3b). Another patient noted that the technology could be “complicated” for someone who does not use “technology on the daily.” Two patients experienced internet connectivity issues and, in both instances, the physician and the APRN made an in‐person home visit.

4. Discussion

In this qualitative analysis, we found that RHH patients reported positive perceptions around the quality and safety of care they received. Several factors may have contributed to this, including a strong patient−provider relationship, receiving effective medical care in the home, and an increased sense of safety at home. Patients emphasized the healing benefits of being at home, such as improved social support, access to home‐cooked meals, better sleep, and physical activity. These findings align with previous studies suggesting patient perception and experience of acute care is similar or better in the home [15, 21].

Technology was generally well received, with some challenges in connectivity or device use noted, but overall acceptance was positive and aligned with prior findings of comfort and accessibility [10, 11, 13]. RHH patients described having an excellent relationship with the care team, noting more quality time and personalized care compared to their prior experiences in the BAM hospital. Home visits provided insight into daily life and social context, enabling tailored care and contribute to patients feeling heard and valued by their care team. When patients have a good relationship with their healthcare providers, they experience shared feelings of respect and collaboration, which contribute to a strong clinician−patient relationship [22, 23].

Given RHH's hybrid model, patients felt medical care was effective and remote physician quality was satisfactory, consistent with prior studies demonstrating the noninferiority of remote visits and telehealth convenience [24, 25]. Remote physician care is particularly valuable where travel distances are large; rural U.S. residents travel about twice as far as urban residents to reach the nearest hospital [26]. Rural Canadian residents face a similar high travel burden [3]. Telemedicine can improve timeliness and access for rural patients [23, 24]. BHH patients valued reduced exposure to hospital‐acquired infections, a benefit heightened during the COVID‐19 pandemic despite infection control protocols in BAM wards [27, 28, 29].

RHH patients appreciated the comfort and familiarity of being treated at home. Home hospitalization also allowed patients to participate in meaningful activities such as engaging in hobbies without stressors typical on a BAM ward. The BAM hospital environment has been found to have a negative impact on patient outcomes [30, 31, 32]. If the built environment in healthcare can be considered akin to a medical intervention [32], then in HH, the “home” can be considered a therapeutic intervention that promotes healing. A general sense of control over one's sleep, nutrition, and environment is beneficial for patients [15]. This is more challenging to do in a BAM hospital where patients are exposed to various stressors, including sleep disruption [33, 34], mobility restrictions [35], poor nutrition, and harmful sounds [36]. This can lead to poor health outcomes, including increased depression and anxiety [34, 36].

RHH also facilitates family and friend involvement, proximity to loved ones and pets supported meaningful social interaction. Loneliness and social isolation are risk factors for early mortality [37], whereas social relationships support wellness [38]. Maintaining a meaningful everyday life is important to patients’ overall quality of life, and with home hospitalization, patients have more control over their own life during treatment [36, 39].

Remote patient monitoring provides real‐time clinically actionable insights [40, 41] and likely contributed to patients perceived safety and comfort. Access to high‐speed internet is still a challenge in parts of rural America [42]. Programs should plan for portable broadband satellite and 4G/5G antennas to help bolster reliability and care continuity [40].

Our study has limitations: we did not interview patients in the control arm; most participants were White, limiting generalizability. To our knowledge, this is the first qualitative analysis of an RHH RCT. Findings support future RHH efforts and show that HH is often preferred by patients.

5. Conclusions

In our qualitative study of patients receiving RHH care, we found that HH patients had a positive experience, attributed to their perception of receiving high‐quality acute‐level care from their providers and increased sense of comfort and safety in the home. Our qualitative findings provide context for the patient experience observed in our RCT and provide insight into the aspects of care that patients valued most [12].

Funding

The study was funded by the Thompson Family Foundation.

Disclosures

David Levine:

• Biofourmis: royalty

• Feminai: scientific advisor

• OutcomesAI: scientific advisor

All other authors: None.

Conflicts of Interest

The authors declare no conflicts of interest.

Interview guide.

1.

Hello, my name is [INTERVIEWER NAME] and I will be guiding the discussion today. We are going to talk about your recent home hospital experience. Thank you so much for talking with me; we want to learn from you. This conversation will help us understand and develop better a home hospital program for rural patients. Please remember that there are no right or wrong answers, we just want to hear about your experience and opinions. If a question or word is unclear, please let me know and I will explain it. Today's discussion will last around 30 min and it will be audio recorded. Your name will not be linked to the responses when we present our findings. Are there any questions before we start? I'm going to begin recording now. Tell me about your experience being home hospitalized What did you like about being home hospitalized? What did you not like? What challenges did you encounter, if any? What was your comfort level during home hospitalization? [Probe for specific examples if they ever felt uncomfortable] What did you think about the patient materials such as the welcome packet? a.Is there any additional information that would be helpful? What was your experience like with the RN/EMT‐P? What was your experience like with the Physician? [Probe on what their experience was like having a remote physician] How confident did you feel in the care that was provided? What was your experience like with the technology? If patient needs a reminder: televisits with physician, patient monitoring [Probe on usability, internet connectivity, comfort level with tech] How did you feel your relationship with the doctor and RN/EMTP differed in the rural home hospital setting versus typical care in a hospital? Would you recommend home hospital to a family member or friend? [Probes: Why or why not?] Do you have any suggestions that could improve the home hospital experience? Those are all the questions I have for you. Is there anything else you want to share about your recent home hospitalization? Is there anything else that you think is important for me to know?Thank you for speaking with me today