Challenges and benefits of hospital-at-home care in Iran from providers and patients’ insights

Hospital-at-home (HaH) care is considered an alternative to inpatient hospitalization. This model of care can serve as an innovative approach aimed at enhancing service delivery while reducing the costs associated with hospital readmissions. The objective of this study was to explore the challenges and advantages of hospital-at-home care from the perspectives of specialists, care providers, and recipients in Iran. This qualitative study was conducted in 2024 using semi-structured interviews. The research population included specialists involved in the implementation of hospital-at-home care programs, as well as providers and recipients of these services in Iran. A total of 27 participants were selected through purposive and snowball sampling. Data analysis was performed using a latent content analysis approach. The software MAXQDA10 was utilized to extract main and subcategories. The content analysis of interviews led to the identification of 50 open codes in total. Among them, 20 codes were categorized under four main themes related to the benefits of hospital-at-home care, including improvement in care delivery, societal and cultural benefits, availability of necessary infrastructure, and cost savings. Meanwhile, 30 codes were classified under seven main themes related to the challenges of hospital-at-home care, including decision-making and policy challenges, time and space limitations (spatial and temporal limitations), legal and ethical challenges, societal and cultural barriers, service delivery constraints, human resource-related challenges, and economic difficulties. The findings of this study highlight both the advantages and challenges of hospital-at-home care in Iran. Given these results, planning by healthcare system managers and policymakers to assess and address the obstacles facing this model of care is crucial. In this regard, several concrete recommendations can be made to enhance the effectiveness of hospital-at-home services. These include adjusting service tariffs to realistic levels, allocating a designated government budget, expanding legally authorized HaH centers, training and developing a skilled workforce, and providing incentive mechanisms such as financial incentives for service providers.