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An Oncology Hospital at Home Model of Acute Care Shows Promise

Innovative model of oncology care may reduce unplanned healthcare utilisation and costs in cancer care delivery
21 May 2021
Bioethics, legal and economic issues;  Palliative and supportive care

An oncology hospital at home shows promise for provision of acute care to patients at home while improving value and reserving inpatient beds and emergency department services for critically ill patients according to an article published on 17 May 2021 in the Journal of Oncology. Healthcare utilisation and costs were markedly decreased for those involved in the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, US home programme in comparison with a usual care cohort who did not receive hospital at home services.

The authors wrote that there are few models of care that address the home support needs of patients with cancer or provide alternatives to emergency department use and readmission for unresolved and emergent symptoms and acute toxicities. Patients with cancer may benefit from additional approaches to care in the home setting, especially when acute monitoring and services are needed to resolve symptoms and toxicities. The hospital at home model of care is an approach that has demonstrated efficacy in non-oncology populations. There is increasing interest in evaluating this model in adult oncology.

Such programmes could keep patients at home, provide services that would otherwise require hospitalisation, and better control symptom fluctuations while protecting immunosuppressed and frail patients with cancer from exposure to hospital-acquired bacterial and viral infections. Such programmes also have the potential to reduce costs.

In this study, the authors evaluated an adult oncology hospital at home programme's rate of unplanned hospitalisations and healthcare costs and secondary outcomes included emergency department use, length of hospital stays, and intensive care unit admissions during the 30 days after enrolment.

They conducted a prospective, non-randomised, real-world cohort comparison of 367 hospitalised patients with cancer of whom 169 consecutively admitted after hospital discharge to a hospital at home programme, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for home programme, but those in usual care lived outside provision of such service area.

Groups were comparable except that more women received home care. In propensity-weighted analyses, the odds ratio (OR) of unplanned hospitalisations was reduced in the home group by 55% (OR 0.45, 95% confidence interval [CI] 0.29 to 0.70; p < 0.001) and healthcare costs were 47% lower (mean cost ratio, 0.53; 95% CI 0.39 to 0.72; p < 0.001) over the 30-day period.

Secondary outcomes also favoured home programme. Total hospital stay days were reduced by 1.1 days (p = 0.004) and emergency department visits were reduced by 45% (OR 0.55; 95% CI 0.33 to 0.92; p = 0.022). There was no evidence of a difference in intensive care unit admissions.

Patients with cancer experience high rates of morbidity and unplanned healthcare utilisation and may benefit from new models of care. Significant improvements in healthcare utilisation may be achievable through oncology hospital at home programmes. This evaluation supports further consideration and study of this innovative model of oncology care. However, the authors emphasised that the benefits will only be realised if new payment models recognise the value of providing cancer care at home.

The study was supported by Cambia Health Foundation grant.

Reference

Mooney K, Titchener K, Haaland B, et al. Evaluation of Oncology Hospital at Home: Unplanned Health Care Utilization and Costs in the Huntsman at Home Real-World Trial. JCO; Published online 17 May 2021. DOI: 10.1200/JCO.20.03609.

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