Authors: Karen Alexandra Titchener, Lorinda A Coombs, Shannon Shepherd, John Harris Ward, Karen Ameloot, Kimberly Dumas, Anna Catherine Beck, Kathi Mooney
Published: 2020-10-08
DOI: 10.1200/jco.2020.38.29_suppl.5
Source: Full article
5 Background: Hospital at Home provides acute hospital level care to patients in their homes, diminishing the need for inpatient care or emergency department (ED) use. It has been evaluated for a variety of acute and chronic conditions but not in adult oncology. Results from program evaluations have demonstrated equivalent or improved outcomes with lower health care utilization and costs and high patient satisfaction when compared to usual care. The first evaluation of an oncology Hospital at Home program in the United States, Huntsman at Home (HH) was launched in 2018 to provide acute level care after hospitalization and address emergent symptoms that arise in the home between clinic visits. We describe the structure and patient profile of HH over the first 15 months of service. Methods: We compiled data for the 169 cancer patients admitted to HH between 8/2018 and 10/2019. We examined patient characteristics, the reason for referral, team structure, services provided and provider visit pattern. Results: The 169 patients referred to HH were predominately female (62%), white (83%), with metastatic disease (79%) and an average age 62 years. The most common diagnoses were GI, lung, GU and GYN cancer. All required acute level medical care and were referred by their oncology or inpatient provider after hospitalization. The HH multidisciplinary team was led by 9 nurse practitioners (NP) partnering with palliative care hospitalists, and the patient’s oncology team. Registered nurses (RN) and other home health personnel were provided by a community-based home health agency. The most common reasons for referral were acute pain, dehydration and electrolyte imbalance, infection, unstable symptoms, failure to thrive and post-surgical needs. The most common interventions provided by HH were: assessment and management of symptoms, medication monitoring and titration, monitoring lab chemistries, intravenous management and administration of medications and fluids, and wound, drain and line assessment and care. Home visits varied based on need; generally, there were 3 NP visits with 5 RN visits in the first week. Health care utilization and cost outcomes were recently reported at the ASCO Virtual Scientific meeting and demonstrated HH patients had fewer hospitalizations, shorter length of stay, decreased ED use and lower costs than the comparison group. Conclusions: HH has proven to be an effective and efficient way to successfully manage a variety of oncology acute care needs in patients’ homes averting further hospitalization or ED use. Hospital at home shows promise as an oncology care delivery model.