Oncology hospital at home programs have shown benefits for patients by decreasing unplanned health care utilization while improving quality of life. Although most hospital at home programs serve local urban areas, research led by Kathi Mooney PhD, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, presented a case study at the 2022 ASCO Annual Meeting that shows how cancer patients living in rural communities also can receive the benefits of these programs.

“Rural oncology hospital at home is feasible and addresses geographic disparities in equitable access to acute and subacute cancer care in local communities,” wrote Dr Mooney and colleagues.

The research team began by redesigning its urban Huntsman at Home program for 3 rural communities in Southeastern Utah that were up to a 5-hour drive from Huntsman Cancer Institute. The authors collected patient data and program modifications required for rural community delivery during the program’s first 6 months. Care was delivered by on-ground and telehealth nurse practitioner visits and on-ground registered nurse and physical therapy visits. 

A total of 47 cancer patients (31 men; 16 women; mean age 69 years) were admitted to the program during its first 6 months. Seven patients had 9 acute illness episodes of care. The average length of acute episode care was 6.1 days for treatment of infection, respiratory distress/hypoxia, cardiac instability (hypotension, tachycardia), and dehydration/electrolyte imbalance and uncontrolled vomiting. Forty patients received subacute management aimed to prevent acute episodes and escalation to the emergency department (ED) or hospitalization. Subacute patients were in the program an average of 15.8 days. There were 4 escalations (2 hospitalizations, 1 ED visit returned to home and 1 ED visit with hospitalization) for symptoms related to disease progression requiring imaging and hospital-based procedures and one for diagnosis of a postsurgical PE. Geographic and social determinates of health impacted rural patients’ cancer burden, most notably transportation barriers (44.7%). A significant number of patients experienced financial hardships (29.8%) related to lost wages, co-pays, and/or out of pocket expenses for care. Lack of health literacy impacted 48.9% of patients effectively navigating their health care and self-management at home. Food insecurity impacted nutritional status in 14.9% of patients. 

“Robust communication and coordination between the hospital at home clinical team, local primary care providers, the rural hospital, community resources and the patients’ cancer center oncology team were keys to improving care pathways,” concluded Dr Mooney and colleagues.

Source:

Mooney K, Dumas K, Fausett A, et al. Oncology hospital at home in rural communities: The Huntsman at Home rural experience. Abstract presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago, IL, and virtual. Abstract 1535.