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Oncology Hospital-at-Home Program Reduced Unplanned Health-Care Utilization and Costs


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In the Huntsman at Home Real-World Trial reported in the Journal of Clinical Oncology, Mooney et al found that an oncology hospital-at-home program reduced unplanned health-care utilization and costs vs usual care among patients with cancer discharged from the hospital.

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.
— Mooney et al

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Study Details

In the study, among 367 consecutive patients being discharged from hospital at Huntsman Cancer Institute who met clinical criteria for the Huntsman at Home (HH) program admission, 169 were admitted to the program and 198 patients were assigned to usual care. Those assigned to usual care lived outside the HH service area.

Criteria for the program included requirement for continued acute-level medical care after hospitalization or continuing unstable symptoms related to treatment or disease progression.

Program services could include:

  • Acute symptom management
  • Clinical monitoring of cardiovascular parameters and oxygen therapy
  • Laboratory value monitoring and replacement
  • Medication titration
  • Intravenous administration of fluids, antibiotics, and other intravenous medications (excluding chemotherapy or other anticancer infusions).

Visits were determined by need and typically included three nurse practitioner (NP) and five registered nurse (RN) visits during the initial week. Occasionally, several RN visits per day along with daily NP visits were required.

Primary outcome measures were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, intensive care unit (ICU) admissions, and emergency department visits during the 30 days after enrollment.

Key Findings

In propensity-weighted analyses, the risk of unplanned hospitalizations was reduced in the HH group vs usual care group by 55% (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.29–0.70, P < .001), with one or more unplanned hospitalization reported for 19.5% vs 35.4%. Health-care costs were reduced by 47% (mean cost ratio = 0.53, 95% CI = 0.39­­–0.72, P < .001), with mean cost per patients of $4,399 vs $9,180.

Total hospital stay days were reduced by 1.1 days (1.4 vs 2.6 days, P = .004). Emergency department visits were reduced by 45% (OR = 0.55, 95% CI = 0.33–0.92, P = .022), with one or more visit for 14.2% vs 23.2%. No difference in ICU admissions was observed (≥ 1 for 7.1% vs 9.1%, P = .972).

The investigators concluded, “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.”

Kathi Mooney, PhD, RN, of Huntsman Cancer Institute, University of Utah, Salt Lake City, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by a grant from the Cambia Health Foundation. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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