Evaluation of Oncology Hospital at Home: Unplanned Health Care Utilization and Costs in the Huntsman at Home Real-World Trial

Abstract

PURPOSE Patients with cancer experience high rates of morbidity and unplanned health care utilization and may benefit from new models of care. We evaluated an adult oncology hospital at home program's rate of unplanned hospitalizations and health care costs and secondarily, emergency department (ED) use, length of hospital stays, and intensive care unit (ICU) admissions during the 30 days after enrollment. METHODS We conducted a prospective, nonrandomized, real-world cohort comparison of 367 hospitalized patients with cancer—169 patients consecutively admitted after hospital discharge to Huntsman at Home (HH), a hospital-at-home program, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for HH admission, but those in usual care lived outside the HH service area. Primary outcomes were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, ICU admissions, and ED visits during the 30 days after enrollment. RESULTS Groups were comparable except that more women received HH care. In propensity-weighted analyses, the odds of unplanned hospitalizations was reduced in the HH group by 55% (odds ratio, 0.45, 95% CI, 0.29 to 0.70; P < .001) and health care costs were 47% lower (mean cost ratio, 0.53; 95% CI, 0.39 to 0.72; P < .001) over the 30-day period. Secondary outcomes also favored HH. Total hospital stay days were reduced by 1.1 days ( P = .004) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI, 0.33 to 0.92; P = .022). There was no evidence of a difference in ICU admissions ( P = .972). CONCLUSION This oncology hospital at home program shows initial promise as a model for oncology care that may lower unplanned health care utilization and health care costs.

Lessons for Oncology From the COVID-19 Pandemic

“…Data collected from wearable and nonwearable connected devices have been shown to correlate with clinically meaningful outcomes such as treatment toxicity and self-rated quality of life 14 . A recent prospective trial also showed that an intensive home hospital program for cancer patients reduced unplanned admissions and emergency room visits and substantially lowered the costs of care 85 …”

“…In addition, the evidence on how wider adoption of virtual care impacts overall health care utilization and costs remains uncertain. Some data suggest increased use of telehealth may prevent avoidable acute care encounters 83,85 . However, there remain concerns that telehealth may increase the overall number of visits.…”

“…14 A recent prospective trial also showed that an intensive home hospital program for cancer patients reduced unplanned admissions and emergency room visits and substantially lowered the costs of care. 85 Virtual care also has the ability to help manage health system capacity. Experiences at high-volume cancer centers during COVID-19 showed that conversion to virtual care helped maintain clinic volumes during the pandemic.…”

Home hospital as a disposition for older adults from the emergency department: Benefits and opportunities

“…For example, a recent trial found decreased cost and healthcare use among patients with cancer hospitalized at home. 54 , 55 Studies published 2 decades ago demonstrated that patients with neutropenic fever may be treated at home with antibiotics and close monitoring and thus may be great candidates for home hospitalization. 56 Furthermore, other illnesses may be amenable to home hospital care by further exploring the literature and innovating care protocols.…”

Quality of Life and Symptom Management in Advanced Biliary Tract Cancers

“…Hospital-at-home programs have been proposed as a model for integrating palliative care that would address patients' needs at home or provide alternatives to emergency department (ED) use and hospitalization. Mooney and colleagues conducted a prospective, nonrandomized, real-world cohort comparison of patients managed an oncology hospital at home program or standard of care [105]. The hospital at home intervention was associated with fewer unplanned hospitalizations, shorter hospital length of stay, and fewer ED visits.…”