Hospital in the Home Program - Department of Human Services Victoria Australia

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If you would like to obtain additional historical information about the Hospital in The Home program, including information about costing studies, audits and development projects please visit our archive

What is HITH?

In 1994 the Hospital in the Home (HITH) Program was commenced as a pilot program. Hospitals were invited to apply to become HITH providers and 43 were selected. 47 services now deliver HITH across Victoria.
Hospital in the home is the provision of hospital care in the comfort of the persons own home, or other suitable environment.
Patients are regarded as hospital inpatients and remain under the care of their treating doctor in the hospital.
Patients receive the same treatment that they would have received had they been in an inpatient hospital bed.
Patients may be able to receive all their hospital care in HITH or they may have a stay in hospital then receive HITH in the latter part of their treatment.
Participation in HITH is voluntary – patients and their carers must agree to have their care provided at home.
There are no additional charges to patients for being in HITH.

Funding was initially provided as a block grant to help establish programs in public hospitals. HITH programs are now funded through the normal inpatient payment, or “Casemix” (Weighted Inlier Equivalent Separation or WIES) system.

HITH in Victoria

HITH has been growing steadily in the 14 years since the pilot programs began.

The most common conditions and treatments delivered by HITH are intravenous antibiotic therapy for cellulitis, genitourinary tract or respiratory tract infection, anticoagulant therapy and chemotherapy. Some HITH services have evolved to offer advanced nursing care to patients with a high level of dependency and acuity, depending on the hospital delivering the service, e.g. transplant centres.

Who can access HITH?

Any public patient of the 47 participating hospitals who is:

assessed as being clinically stable
appropriately supported in the home, i.e. presence of a carer or support person
living in a suitable environment, with access to a telephone
willing to be treated by HITH
suitable for HITH treatment

How does HITH work?

Patients may be admitted to HITH in different ways, depending on their condition and treatment. Some patients may be directly admitted from the Emergency department or the community, or may have a stay in hospital first, and can then be transferred into HITH to continue their treatment (for example after surgery or after their condition has stabilised).
There are different models of HITH care. Usually the patient is visited by a member of the HITH team at least once a day, this may be a nurse, doctor or allied health professional. In some situations the patient may be asked to come to the hospital to receive a component of the treatment or for further investigation or review.

All HITH programs provide access to on call staff at nights or weekends. Most have arrangements for their patients to present back to the hospital, usually via the Emergency Department

Benefits of HITH

Patients prefer to be treated in the comfort of their own home, with their family and friends around them, rather than in hospital
Carers and relatives prefer the patient to be at home
Research findings demonstrate that patients have improved outcomes and recovery at home against a range of clinical markers including delirium, confusion and clinical symptoms. (Caplan G. MJA 2006;184(12):599-600)
Clients can resume normal activities and routines quickly, and recover well at home
Hospitals can manage their beds more efficiently
HITH can be provided at a lower cost than inpatient hospital care
Care delivered by HITH is free to the patient.

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Hospital in the Home Review 2009

The Department of Human Services has commenced a review of Hospital in the Home (HITH) services across Victoria.

The HITH Programs have been in operation for fifteen years, and bring a range of benefits to both patients and health services, including reduced length of stay in hospital, improved flow through hospital beds, and improved outcomes for patients cared for in their own home environment. In that time there has been no formal review of the HITH Program.

The main objectives of the review are to:

Review the current HITH Programs to evaluate role and function, referral processes, funding models, workforce issues, medical governance arrangements, guidelines and data systems;
Develop recommendations for future directions of HITH Programs to ensure that they deliver person-centred health care, and are equitable across Victoria;
Review the literature and models of HITH care, both nationally and internationally, to identify practices which may improve the patient experience receiving hospital care at home;
Explore the admission avoidance and diversion role of HITH, in conjunction with the residential in reach pilot for the winter demand strategy;
Review the current relationships of the HITH Program with other health independence programs, such as Post Acute Care (PAC), Sub-acute Services (SACS) and Hospital Admission Risk Program (HARP) that provide access to post-hospital and/or preventative supports to identify opportunities to ensure that the right care is being provided in the right place and at the right time by the right team;
Review the relationships between HITH programs and the inter-HITH referral processes and catchments;
Outline new service delivery model if indicated by the findings, to ensure alignment and appropriate delivery of HITH services.

It is planned that the review will conclude in December 2009.

The Department has developed an interim Advisory Group for the tenure of this project, and is working with HITH Program Managers to facilitate the review process. This has involved meeting with Program Managers and developing a regular discussion forum.

Review of Hospital in the HomePrograms - Summary Findings (PDF File 145KB)