Section of General Internal Medicine, Yale School of Medicine, New Haven, CT.
National Clinician Scholars Program, Yale School of Medicine and VA Connecticut Healthcare System, New Haven, CT.
JCO Oncol Pract. 2021 Apr;17(4):e556-e563. doi: 10.1200/OP.20.00663. Epub 2021 Jan 8.
Hospital at home (HaH) is a means of providing inpatient-level care at home. Selection of admissions potentially suitable for HaH in oncology is not well studied. We sought to create a predictive model for identifying admissions of patients with cancer, specifically solid-tumor malignancies, potentially suitable for HaH.
In this observational study, we analyzed admissions of patients with solid-tumor malignancies and unplanned admissions (January 1, 2015, to June 12, 2019) at an academic, urban cancer hospital. Potential suitability for HaH was the primary outcome. Admissions were considered potentially suitable if they did not involve escalation of care, rapid response evaluation, in-hospital death, telemetry, surgical procedure, consultation to a procedural service, advanced imaging, transfusion, restraints, and nasogastric tube placement. Admission source, patient demographics, vital signs, laboratory test results, comorbidities, admission and active cancer diagnoses, and recent hospital utilization were included as candidate variables in a multivariable logistic regression model.
Of 3,322 admissions, 905 (27.2%) patients were potentially suitable for HaH. After variable selection in the derivation cohort (n = 1,097), thirteen factors predicted potential suitability: admission source; temperature and respiratory rate at presentation; hemoglobin; breast cancer, GI cancer, or malignancy of secondary or ill-defined origin; admission for genitourinary, musculoskeletal, or neurologic symptoms, intestinal obstruction or ileus, or evaluation of secondary malignancy; and emergency department visit in prior 90 days. Model c-statistics were 0.71 (95% CI, 0.68 to 0.75) and 0.63 (0.59 to 0.67) in the derivation and validation (n = 1,095) cohorts.
Hospital admissions of patients potentially suitable for HaH may be identifiable using data available at admission.
居家住院（HaH）是在家中提供住院级别的护理的一种方式。在肿瘤学中，选择适合 HaH 的入院患者的方法尚未得到充分研究。我们旨在创建一种预测模型，以识别患有癌症，特别是实体瘤恶性肿瘤的患者的入院情况，这些患者可能适合 HaH。
在这项观察性研究中，我们分析了一家学术性城市癌症医院的实体瘤恶性肿瘤和非计划性入院患者（2015 年 1 月 1 日至 2019 年 6 月 12 日）。潜在的 HaH 适宜性是主要结局。如果入院不涉及护理升级、快速反应评估、院内死亡、遥测、手术、向程序服务咨询、高级影像学、输血、约束、鼻胃管放置，则认为入院适合 HaH。入院来源、患者人口统计学特征、生命体征、实验室检查结果、合并症、入院和活动性癌症诊断以及最近的住院利用情况被纳入多变量逻辑回归模型的候选变量。
在 3322 例入院患者中，有 905 例（27.2%）患者可能适合 HaH。在推导队列（n=1097）中进行变量选择后，有 13 个因素预测潜在适宜性：入院来源；入院时的体温和呼吸频率；血红蛋白；乳腺癌、胃肠道癌或继发或不明来源的恶性肿瘤；因泌尿生殖系统、肌肉骨骼或神经系统症状、肠梗阻或肠麻痹、或继发性恶性肿瘤评估而入院；以及在过去 90 天内的急诊就诊。在推导（n=1097）和验证（n=1095）队列中，模型的 C 统计量分别为 0.71（95%CI，0.68 至 0.75）和 0.63（0.59 至 0.67）。
使用入院时可用的数据，可能可以识别出适合 HaH 的患者的入院情况。
