The first ever reported trial of an adult oncology hospital-at-home program shows strong evidence for reduced hospitalizations, ED visits, and costs, according to a presentation at the American Society of Clinical Oncology (ASCO) Annual Meeting (May 29-31, 2020).
Unplanned hospitalizations and ED visits are common during cancer care, but providing acute hospital-level care at home has the potential of adding value by decreasing hospital and ED use.
Kathleen Mooney, PhD, RN, FAAN, senior director of population sciences, Huntsman Cancer Institute, University of Utah, and colleagues conducted the first ever evaluation of an oncology hospital-at-home program – Huntsman at Home (H@H). Services for H@H began in 2018 and the program continues to accept referrals of cancer patients for acute-medical or post-surgical care at home. Admitted patients require continued acute-level medical care after hospitalization or have unstable symptoms related to treatment or disease progression that would otherwise require ED evaluation or hospitalization.
Researchers prospectively evaluated outcomes for 367 patients who were either referred to H@H from August 2018 through October 2019 (n = 169) or received usual care (n = 198).
The primary outcomes of the study were hospitalizations, length of stay, ED visits, and cumulative charges over 30 and 90 days post-admission to either group. Researchers noted that a variety of cancers were represented in the patient sample, including colon, gynecologic, prostate, and lung.
Dr Mooney and colleagues found that H@H patients were more likely to be female (61% vs 43%, respectively) and showed a trend toward longer length of stay if hospitalized during the month prior to admission (6.7 vs 5.5 days, respectively). However, during the first 30 days after admission, H@H patients had lower hospital length of stay (mean reduction, 1.19 days; P = .022), 56% lower odds of unplanned hospitalizations (OR, 0.44; P = .001), 45% lower odds of ED visits (OR, 0.55; P = .037), and 50% lower cumulative charges (mean ratio, 0.50; P < 001) compared with usual care patients.
Additionally, researchers observed similarly robust results after 90 days.
“Oncology hospital-at-home programs show promise for increased patient-centered care while simultaneously improving value,” authors of the study concluded, adding that they plan to continue evaluating outcomes of patients participating in the program.—Zachary Bessette
