The national Hospital at Home Users Group has developed and will continuously update this toolkit, which contains guidance on waiver eligibility, startup and design, and clinical care delivery for organizations participating in CMS's Acute Hospital Care at Home (AHCAH) program. The Center to Advance Palliative Care (CAPC) serves as a technical assistance development partner to the Users Group.

We want to hear from you! Use this feedback form to tell us about obstacles you're facing in developing your hospital at home program, or to share program tools with the national hospital at home community.

What’s in the Toolkit

Information about the Hospital at Home (HAH) care model and evidence base.

What is Hospital at Home?

Overview from the Hospital at Home Users Group.

Hospital at Home: AHA Information
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American Hospital Association (AHA) information and case studies about Hospital at Home programs.

Hospitalization at Home: Mount Sinai Health System Experience | Brigham and Women's Hospital Experience

CMS webinar overview of the Hospital at Home model and December 2020 CMS waiver. December 9, 2020. Presenters: Linda DeCherrie, MD, and David Levine, MD, MPH, MA.

The Science of Hospital at Home

Published literature on the need for - and impact of - acute care provided in the home.

Upcoming webinars on Hospital at Home program design topics.

2/23 Webinar: How Are We Doing? Evaluating Hospital at Home Quality and Safety
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Drawing from the experience of Brigham Health’s Home Hospital program and others around the country, this webinar will examine a range of quality and safety measurement issues and how these data are essential to generating better outcomes and recruiting institutional funding and support. Presented by the Hospital at Home Users Group.

Epic EHR: 2/24 Acute Hospital Care at Home Webcast
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Panel discussion with three Hospital at Home leaders on best strategies to support HaH delivery through Epic.

UK Hospital at Home Society: 2020-2021 Webinar Series
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Running series of presenting on clinical and programmatic aspects of HaH delivery, including new events and recorded presentations.

Small-group, topic-specific conversations with national Hospital at Home experts. Join to ask questions about your Hospital at Home program, and stay to hear how colleagues across the country are approaching similar questions.

The Hospital at Home Waiver: Conditions of Participation and Assessing Readiness
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Hospital at Home: Patient Eligibility and Clinical Care
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Hospital at Home Program Design and Clinical Operations
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Provision of Ancillary Services for Hospital at Home Patients
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Use of Technology in Hospital at Home: EHR and Patient Care
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Whether your organization can apply, and how to approach the application.

Hospital at Home: Meeting 2020 CMS Waiver Requirements
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How to interpret conditions of participation, and options for program design to meet waiver requirements.

CMS FAQ and Waiver Request

Online waiver application site - scroll down to download the most recent version of the CMS Hospital at Home FAQ.

CMS Waiver Application: For Experienced Hospitals
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Waiver request application for hospitals that had delivered Hospital at Home services to at least 25 patients prior to applying for the waiver. CMS, December 2020.

CMS Waiver Application: For Inexperienced Hospitals
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Expanded waiver request application form for hospitals that did not deliver hospital at home services - or who delivered HaH services to fewer than 25 patients - prior to the waiver. CMS, December 2020.

Successful program design depends upon understanding the needs at priorities of Hospital at Home stakeholders. Use the tools below to design your stakeholder engagement strategy.

Why Hospital at Home - and Why Now?
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Health care trends that make the case for implementing a Hospital at Home program.

Webinar: Building Support for Your Hospital at Home Program - Issues in Strategic Engagement
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HaH Users Group presentation on how to make the case for HaH within your organization, and engage key stakeholders in the design of the service. 1/19/21 recording and slides are available.

5 Key Principles for Hospital at Home Program Design
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Foundational principles for designing or growing the program.

Engaging Stakeholders in Hospital at Home
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Tool for identifying key stakeholders, and tips for productive engagement.

Five Questions to Identify Key Stakeholders
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A short, step-wise process for mapping key stakeholders that can be applied to the Hospital at Home needs assessment process. Harvard Business Review, 2014.

Guidance on designing patient eligibility criteria, including sample inclusion and exclusion criteria, screening guides, and patient consent forms.

Webinar: Who's In? Who's Out? Deciding which Patients are Right for your Hospital at Home Program
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1/28 presentation from the Hospital at Home Users Group on setting eligibility and exclusion criteria for your HaH program, including examples to illustrate key design principles and strategies for educating referrers on eligibility criteria. Webinar recording and slides are available.

Hospital at Home: Patient Eligibility, Referrals, and Intake Processes
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Guidance on implementing patient eligibility and exclusion criteria, evaluating admissions to the Hospital at Home program, and intake protocols.

HaH Referral Workflow: Sample Algorithm
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Decision-making, handoffs, and communication protocols when a patient has been identified as a candidate for Hospital at Home. Note: this resource is a sample; referral workflows should be adapted to meet the needs of each HaH institution.

Sample Screen for Hospital at Home: Mount Sinai Health System
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Screen for logistical criteria and hard exclusion criteria for patients who otherwise meet clinical criteria for the Hospital at Home service. Sample shared by the Icahn School of Medicine at Mount Sinai, 2018.

Sample: HaH Bedside Patient Screening Guide for Admitting Provider
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Safety screening guide for use by the admitting provider for Hospital at Home. Sample shared by the Icahn School of Medicine at Mount Sinai, 2018.

Sample Criteria: Presbyterian Healthcare Services
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Inclusion and exclusion criteria, including geographic radius. Shared by Presbyterian Healthcare Services.

Sample Criteria: Brigham Health
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Sample Hospital at Home patient eligibility criteria. Shared by Brigham Health.

Sample 1: Hospital at Home Consent Form
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Sample patient consent form form Hospital at Home - any consents should be reviewed by the legal counsel and compliance teams at your institution.

Sample 2: Hospital at Home Consent Form
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Sample patient consent form form Hospital at Home - any consents should be reviewed by the legal counsel and compliance teams at your institution.

Sample tools, forms, and technical assistance for Hospital at Home service delivery.

Webinar: Efficient, Effective, Excellent: Issues in Hospital at Home Logistics and Operations
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Drawing from examples at Huntsman in Utah and in other locales, this webinar will examine best practices for ensuring that hospital at home programs can organize and manage the service and staffing needed to deliver high quality acute care. Presentation recording and slides by the Hospital at Home Users Group.

Webinar: On Time, Every Time: Delivering Hospital at Home Ancillary Services
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Delivering a variety of ancillary services is a key requirement of the CMS Acute Hospital Care at Home waiver program, and new and existing programs must ensure that a whole range of services — from labs and imaging to food and durable medical equipment — are available when hospital at home patients need them. Presentation recording and slides by the Hospital at Home Users Group.

Staffing the Hospital at Home Program: Roles, Staff Criteria and Training, and Team Communication
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A profile of the Mount Sinai Hospital at Home staffing model, with guidance for designing staffing roles and hiring an effective team.

Implementation Guide: Mount Sinai Hospitalization at Home and Rehabilitation at Home
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Comprehensive guidance on Hospital at Home program startup including staffing, operations, clinical care model, ancillary services, and quality and safety. Icahn School of Medicine at Mount Sinai, 2018.

How Are We Doing? Evaluating Hospital at Home Quality and Safety
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2/23 webinar presentation by the Hospital at Home Users Group on how to measure, evaluate, and improve upon HaH care quality.

Medication List: Sample Hospital at Home Medication Box Inventory
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Shared by Presbyterian Healthcare Services.

How to incorporate technology for successful HaH operations, including patient monitoring, team communication, and EHR.

Tech Matters: Building the Right Digital Platform for your Hospital at Home Program
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2/2 presentation from the Hospital at Home Users Group on the relationship between technology decisions and HaH program efficacy and quality. Topics include remote patient monitoring, EHR, telemedicine requirements, team communications, Smart Home applications, and ensuring equity. Webinar recording and slides are available.

Using Epic for Hospital at Home
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White paper developed and continuously updated by Epic, including workflows, system configuration, and reporting. This resource is restricted to users at Epic customer organizations.

Webinar: HaH for Epic Users
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Operational guidance and system demo for Hospital at Home programs using Epic. Restricted to Epic users (requires login).

Epic for Hospital at Home: FAQ and Resource List
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Developed by Epic for Epic users designing or delivering Hospital at Home services. Updated January 29, 2021.

Examples from successful Hospital at Home program implementations.

Case Study: Presbyterian Healthcare Services' Hospital at Home Program
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Snapshot of a successful Hospital at Home program including model and outcomes. Published by the Alliance of Community Health Plans.

AHA Hospital-at-Home Podcast and Case Studies
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Issues briefs and program information from leading Hospital at Home sites around the country. Published by the American Hospital Association.