The oncology hospital at home: Health care utilization outcomes from the huntsman at home trial.

Abstract

7000 Background: Unplanned hospitalizations and emergency department (ED) visits are common during cancer care. Providing acute hospital level care at home may add value by decreasing hospital and ED use. We conducted the first evaluation of an oncology Hospital-at-Home program, Huntsman at Home (H@H). Methods: The Huntsman Cancer Institute began H@H services in 2018 and accepts referral of cancer patients for acute-medical or post-surgical care at home. Patients are admitted who require continued acute level medical care after hospitalization or have emergent unstable symptoms related to treatment or disease progression that would otherwise require ED evaluation or hospitalization. Prospectively, patients referred to H@H from 8/2018 through 10/2019 were compared to a usual care comparison group (UC) drawn concurrently from patients living within the Salt Lake City metropolitan area who qualified for admission to H@H, but lived outside the service zip codes. Probability of H@H enrollment propensity scores were constructed via random forest from patient descriptors and health care utilization at admission. We used an intent-to-treat approach for analysis. Primary outcomes were hospitalizations, length of stay (LOS), ED visits and cumulative charges over 30 and 90 days post admission to either group. Comparisons were made by generalized linear models, stratified by tertiles of H@H vs. UC propensity score. Results: 367 patients, 169 H@H and 198 UC, were evaluated. The average age was 62 yrs, 85% were Caucasian, and 77% had stage IV cancer. Propensity score distributions were overlapping, demonstrating group comparability. A variety of cancers were represented; the most common being colon, gynecologic, prostate and lung cancers. Compared to UC, H@H patients were more likely to be female (61% vs 43%) and during the month prior to admission, showed a trend towards longer LOS if hospitalized (6.7 vs 5.5 days). During the first 30 days after admission, propensity stratified comparisons showed H@H patients with lower hospital LOS (mean reduction 1.19 days, p=0.022), 56% lower odds of unplanned hospitalizations (OR 0.44, p=0.001), 45% lower odds of ED visits (OR 0.55, p=0.037) and 50% lower cumulative charges (mean ratio 0.50, p<0.001) compared to UC. Results over 90 days were similarly robust. Conclusions: In the first reported trial of an adult oncology Hospital at Home program, there was strong evidence for reduced hospitalizations, ED visits, and cost. Oncology Hospital at Home programs show promise for increased patient-centered care while simultaneously improving value.

Preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive early breast cancer (PHranceSCa): A randomised, open-label phase II study

“…In PrefHer, 60.4% of patients would hypothetically have preferred SC home administration [13]. This concept of flexible care is being investigated in an 'oncology hospital-at-home program' in the US, which reported fewer hospitalisations and emergency department visits and reduced costs versus standard processes [15]. Chemotherapy at home is a well-embedded UK practice.…”

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.…”

“…We need to invest in research to better understand other conditions that may benefit from home hospital. 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 .…”

The Home is the New Cancer Center

“…H@H reports reduced hospitalizations, ED visits, and total costs among patients who participate in the program. 7 Concerns about safety, feasibility, patient-centeredness, and reimbursement exist for cancer hospital-at-home programs as well. Despite these concerns, however, hospital-at-home models exist and are expanding.…”