Oncology hospital-at-home model reduces hospitalizations, emergency department visits, and costs

The first adult oncology hospital-at-home program in the United States is a promising future model for delivery of acute care to patients outside of hospitals and clinics, especially in the era of COVID-19, according to data featured during the ASCO20 Virtual Scientific Program [1]. 

The Huntsman at Home trial of adult oncology patients began at the University of Utah Huntsman Cancer Institute in 2018. Nurse practitioners and registered nurse teams deliver care directly at the homes of patients with acute needs following hospitalization, those who have unstable symptoms that require urgent evaluation, or those with disease progression that would otherwise require a trip to the emergency department (ED). Backup support is provided by medical oncologists and palliative care teams.

Kathi Mooney, PhD, RN, of the University of Utah Huntsman Cancer Institute, said addressing patients’ acute care needs at home is especially relevant during the COVID-19 pandemic as patients try to limit hospital admissions and ED visits to reduce their exposure to the disease. She said the hospital-at-home concept is poised for “disruptive innovation and evaluation of new models of care” in the United States.

During the first 14 months of Huntsman at Home, the authors reported on 367 patients, of whom 169 were in the Huntsman at Home group and 198 were in the usual care comparison group. Patients in the usual care group were clinically qualified for Huntsman at Home admission but lived outside the service area. The study used an intent-to-treat analysis with propensity weighting to address this pragmatic evaluation that did not include random assignment.

The patients had an average age of 62, 84.7% were white, and 77% had stage IV cancer. The most common malignancies were gastrointestinal, gynecologic, genitourinary, and lung cancers. Compared with the usual care group, the Huntsman at Home patients were more likely to be female and showed a trend toward longer length of stay for a hospitalization during the month prior to admission.

The key findings 30 days after enrollment included a 58% odds reduction in unplanned hospitalizations, a mean odds reduction of 1.19 days in unplanned hospital length of stay, 48% odds reduction in ED visits, and 48% reduction in cumulative costs compared with the usual care group ($10,238 vs. $21,363, respectively).

“Our evaluation demonstrated robust reductions in health care utilization and cost,” Dr. Mooney said. “This was an initial test in a concept in oncology and shows that extending acute-level cancer care into homes and communities of cancer patients—utilizing a hospital-at-home model—can significantly improve patient experience and outcomes.”

The discussant for this abstract was Lynne I. Wagner, PhD, of the Wake Forest School of Medicine and Wake Forest Baptist Comprehensive Cancer Center. She noted the timeliness of the Huntsman model in the era of COVID-19 for acute care at home.

“These results support this model as a promising direction for high-quality, cost-efficient care, which reduces interactions with the health care environment, reducing the risk for COVID-related outcomes,” Dr. Wagner said. She added that costs associated with COVID-19 infections should be estimated to realize the full economic value of this care model given the significant reductions of exposure to the disease afforded by home-based visits.

Dr. Wagner noted the investigators’ concerns over the lack of a payment model as a significant challenge to sustainability, suggesting that capturing these cost metrics and continuing to validate this care model during the Centers for Medicare & Medicaid Services’ current waiver of certification of homebound status will move the needle in adopting more innovative patient-centered models of care.

1. Mooney K, et al. ASCO Virtual Meeting, 29-31 May 2020, Abstract 7000.

Posted on 28 August 202017 September 2020