Hospital-at-home network in Finland

Introduction: Hospital-at-home (HAH) may provide cost-effectively high-quality care for patients otherwise requiring inpatient ward care. However, large-scale nation-wide studies on HAHs and their effectivity are lacking. Methods: A web-based questionnaire, directed to 56 HAHs identified in Finland, was used to gather information on the performance, quality and future plans of the Finnish HAHs. The national recommendations and guidelines were searched for HAH-related contents. Results: The response rate was 60.7% (N = 34). All the HAHs that responded were functioning in public municipal healthcare. The median catchment population per a HAH was 40,970 and the median number of patients was 5435 in 2015, and the major reasons for admission were parenteral antibiotic treatment for infections and end-of-life care. The staff of HAHs consisted mostly of nurses. The administration and financing of the HAHs were arranged varyingly, and no uniform quality control system could be detected. Although there are national guidelines acknowledging the presence of HAHs they do not regulate their operations in any way. Conclusion: A large HAH network, based mostly on nursing activities, has been established in Finland and a tendency to increase the availability of the service can be recognized. New national guidelines regulating the service should be composed.