Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium.
JCO Glob Oncol. 2021 Sep;7:1564-1571. doi: 10.1200/GO.21.00158.
Given the increasing burden of cancer on patients, health care providers, and payers, the shift of certain outpatient procedures to the patients' homes (further indicated as oncologic home-hospitalization [OHH]) might be a high-quality, patient-centered, and cost-effective alternative to standard ambulatory cancer care (SOC).
A randomized-controlled trial was conducted to evaluate the quality of a locally implemented model for OHH (n = 74) compared with SOC (n = 74). The model for OHH consisted of home administration of certain subcutaneous cancer drugs (full OHH) and home nursing assessments before ambulatory systemic cancer therapy (partial OHH). Quality was evaluated based on patient-reported quality of life (QoL) and related end points; service use and cost data; safety data; patient-reported satisfaction and preferences; and model efficiency. An equivalence design was used for primary end point analysis. Participants were followed during 12 weeks of systemic cancer treatment.
This trial demonstrated equivalence of both models (OHH SOC) in terms of patient-reported QoL (95% CI not exceeding the equivalence margin of 10%). Full OHH resulted in significantly less hospital visits (mean of 5.6 ± 3.0 13.2 ± 4.6; = .011). Partial OHH reduced waiting times for therapy administration at the day care unit with 45% per visit (2 hours 36 minutes ± 1 hour 4 minutes 4 hours ± 1 hour 4 minutes; < .001). No safety issues were detected. Of the intervention group, 88% reported to be highly satisfied with the OHH model, and 77% reported a positive impact on their QoL. At study end, 60% of both study arms preferred OHH above SOC.
The shift of particular procedures from the outpatient clinic to the patients' homes offers a high-quality and patient-centered alternative for a large proportion of patients with cancer. Further research is needed to evaluate potential cost-efficiency.
鉴于癌症给患者、医疗保健提供者和支付者带来的负担不断增加，将某些门诊程序转移到患者家中（进一步表示为肿瘤患者家庭住院[OHH]）可能是一种高质量、以患者为中心且具有成本效益的替代标准门诊癌症护理（SOC）的方法。
进行了一项随机对照试验，以评估局部实施的 OHH 模型（n = 74）与 SOC（n = 74）的质量。OHH 模型包括在家中管理某些皮下癌症药物（完全 OHH）和在门诊全身癌症治疗前进行家庭护理评估（部分 OHH）。质量评估基于患者报告的生活质量（QoL）和相关终点；服务使用和成本数据；安全性数据；患者报告的满意度和偏好；以及模型效率。主要终点分析采用等效设计。参与者在 12 周的全身癌症治疗期间接受随访。
该试验表明，两种模式（OHH SOC）在患者报告的 QoL 方面具有等效性（95%CI 不超过 10%的等效性边界）。完全 OHH 导致医院就诊次数明显减少（平均值分别为 5.6 ± 3.0 13.2 ± 4.6； =.011）。部分 OHH 使日间护理单位的治疗管理等待时间减少了 45%/次（2 小时 36 分钟 ± 1 小时 4 分钟 4 小时 ± 1 小时 4 分钟； <.001）。未发现安全问题。干预组中有 88%的人报告对 OHH 模式非常满意，77%的人报告对他们的 QoL 有积极影响。研究结束时，两个研究组的 60%都更喜欢 OHH 而不是 SOC。
将特定程序从门诊转移到患者家中，为大多数癌症患者提供了一种高质量且以患者为中心的替代方法。需要进一步研究以评估潜在的成本效益。
