Hospital at home: from international evidence to a China-oriented pathway—building an integrated hospital–community–home model for respiratory home hospitalization coordinated with cloud outpatient care, with evaluation of clinical safety, environment

Objective To synthesize the international evidence, implementation models, and barriers related to Hospital at Home (HaH), and to propose a China-oriented pathway for respiratory HaH by integrating family bed services, internet hospitals, internet-based medical services, Internet Plus Nursing Services, and community health services. Contemporary evidence suggests that HaH has evolved beyond a simple substitute for inpatient admission and is increasingly understood as a composite model of hospital-level acute care delivered outside the hospital through remote monitoring, virtual review, in-home nursing, home-based treatment, and rapid escalation pathways. Methods This review draws on recent systematic reviews, randomized trials, real-world studies, implementation research, and national and local policy documents. The analysis focuses on conceptual boundaries, the international evidence base, key respiratory indications, digital infrastructure, nursing and community coordination, and multidimensional evaluation across clinical safety, environmental footprint, social benefit, and economic value. Results Among appropriately selected patients, HaH appears comparable or superior to conventional inpatient care with respect to mortality, readmission, patient experience, functional recovery, and some cost-related outcomes. Respiratory conditions, particularly post-exacerbation management of chronic obstructive pulmonary disease, home oxygen therapy, home noninvasive ventilation, post-pneumonia transitional care, and intensified post-discharge follow-up, represent high-priority and operationally feasible scenarios for HaH. China already has several institutional components relevant to HaH, including family bed services, internet hospitals, internet-based diagnosis and treatment, Internet Plus Nursing Services, and community health services. However, these components remain only partially connected and require specialty-led integration, digital coordination, nursing execution, and community continuity to form an operational, evaluable, and scalable pathway. Environmental gains should not be assumed; instead, transport, hospital bed utilization, household energy use, consumables, waste, and digital infrastructure should all be assessed within a full-pathway framework. Conclusions HaH has developed into a model of hospital-level care outside the hospital that integrates remote monitoring, virtual rounds, in-home nursing, home-based treatment, and rapid escalation and referral. For China, the key issue is not whether HaH is conceptually feasible, but how existing institutional mechanisms can be reorganized into an integrated hospital–community–home pathway for respiratory care. Future implementation should be evaluated across four domains: clinical safety, environmental footprint, social benefit, and economic value.

Key Words: hospital at home; home hospitalization; respiratory disease; family bed services; internet hospital; Internet plus nursing services; environmental footprint; social benefit; economic value.