Implementing cross-sector hospital-at-home treatment: challenges, opportunities and action research insights

As healthcare systems around the world face the demographic challenge of aging populations, innovative care models such as hospital-at-home are emerging as promising alternatives to traditional hospitalization. This paper investigates the implementation of a cross-sectoral admission avoidance hospital-at-home model in Denmark, developed collaboratively by a hospital emergency department, three municipalities, and general practitioners. The model aims to provide acute medical care to elderly patients in their own homes, minimizing hospital stays, and reducing risks associated with hospitalization.Employing an action research approach, this study captures the dynamic process of implementing the hospital-at-home model. The methodology emphasizes iterative learning cycles, collaborative problem solving, and stakeholder engagement. The implementation process is analyzed using policy implementation theory, with a focus on an interplay between inter-organizational behavior, leadership, and front-level staff roles.The findings highlight the importance of trust, communication, and flexibility in fostering effective cross-sectoral collaboration. Practical tools, such as structured task descriptions and regular dialogue and reflection meetings, proved instrumental in overcoming barriers and aligning diverse stakeholder practices. Challenges, including logistical complexities and resistance to role changes, were addressed through real-time adjustments facilitated by the action research approach.This study provides actionable insights into the implementation of hospital-at-home models, emphasizing the value of cross-sectoral collaboration and iterative learning. The findings underscore the potential of such models to improve care quality for elderly patients while alleviating pressures on healthcare systems. Future research should focus on evaluating long-term outcomes and exploring scalability in diverse settings.