Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
School of Nursing, University of North Carolina, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
J Clin Oncol. 2021 Aug 10;39(23):2586-2593. doi: 10.1200/JCO.20.03609. Epub 2021 May 17.
Patients with cancer experience high rates of morbidity and unplanned health care utilization and may benefit from new models of care. We evaluated an adult oncology hospital at home program's rate of unplanned hospitalizations and health care costs and secondarily, emergency department (ED) use, length of hospital stays, and intensive care unit (ICU) admissions during the 30 days after enrollment.
We conducted a prospective, nonrandomized, real-world cohort comparison of 367 hospitalized patients with cancer-169 patients consecutively admitted after hospital discharge to Huntsman at Home (HH), a hospital-at-home program, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for HH admission, but those in usual care lived outside the HH service area. Primary outcomes were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, ICU admissions, and ED visits during the 30 days after enrollment.
Groups were comparable except that more women received HH care. In propensity-weighted analyses, the odds of unplanned hospitalizations was reduced in the HH group by 55% (odds ratio, 0.45, 95% CI, 0.29 to 0.70; < .001) and health care costs were 47% lower (mean cost ratio, 0.53; 95% CI, 0.39 to 0.72; < .001) over the 30-day period. Secondary outcomes also favored HH. Total hospital stay days were reduced by 1.1 days ( = .004) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI, 0.33 to 0.92; = .022). There was no evidence of a difference in ICU admissions ( = .972).
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.
癌症患者发病率高且经常需要非计划性的医疗保健，因此可能受益于新的医疗模式。我们评估了一个成人肿瘤医院居家项目的非计划性住院率和医疗保健费用，次要评估指标包括登记后 30 天内的急诊（ED）就诊、住院时间和重症监护病房（ICU）入院率。
我们进行了一项前瞻性、非随机、真实世界的队列比较，比较了 367 例癌症住院患者的情况，其中 169 例连续入院，在出院后接受 Huntsman at Home（HH）居家项目治疗，这是一个医院居家项目，与 198 例同时期在医院出院的常规护理患者进行对比。所有患者均符合 HH 入院的临床标准，但常规护理患者居住在 HH 服务区域之外。主要结局是登记后 30 天内的非计划性住院次数和费用。次要结局包括登记后 30 天内的住院时间、ICU 入院和 ED 就诊。
两组患者除了 HH 组接受护理的女性更多外，其他方面均无差异。在倾向评分加权分析中，HH 组非计划性住院的可能性降低了 55%（优势比，0.45；95%CI，0.29 至 0.70；<.001），医疗保健费用降低了 47%（平均费用比，0.53；95%CI，0.39 至 0.72；<.001）。次要结局也有利于 HH 组。总住院天数减少了 1.1 天（ =.004），ED 就诊减少了 45%（优势比，0.55；95%CI，0.33 至 0.92； =.022）。ICU 入院率没有差异（ =.972）。
该肿瘤医院居家项目初步显示出作为肿瘤护理模式的潜力，可能降低非计划性医疗保健利用率和医疗保健费用。
