Baugh Christopher W, Dorner Stephen C, Levine David M, Handley Nathan R, Mooney Kathi H
Department of Emergency Medicine, Brigham & Women's Hospital, Neville House 2Nd Floor, 75 Francis Street, Boston, MA 02115 USA.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA.
Emerg Cancer Care. 2022;1(1):8. doi: 10.1186/s44201-022-00008-3. Epub 2022 Jul 1.
Patients with cancer constitute a large and increasing segment of patients who receive unscheduled hospital-based care due to treatment-related symptoms and disease progression. The initial hospital-based touchpoint for these unscheduled hospitalizations is often the emergency department. Traditional models of emergency department and inpatient hospital-based care are saturated and incapable of scaling to accommodate the future, increased needs projected for this population. New models of care are necessary to address this gap. Acute home-based care is a promising tool potentially providing patient-centric, efficient care to eligible patients.
We applied Porter's Five Forces framework that addresses the bargaining power of buyers and suppliers, threat of substitutes and new entrants, and industry rivalries plus the sixth force of regulation to clarify the factors that will promote or challenge the adoption of a home-based cancer care referral model before or following emergency department visits. Exploring this framework provides insights into the complexities of scaling an acute home-based cancer care model and highlights ways for health systems including hospitals, emergency departments, physician groups, and individual emergency physicians and oncologists to optimize their roles in this emerging model of care.
We found that current workforce shortages, as well as workflow, infrastructure, and regulatory complexities, pose major challenges that unless carefully addressed may restrict the growth of acute home-based cancer care. Additional uncertainties persist around appropriate payment models and the competitive landscape. Key promoting factors include the recognized need in the cancer community and among payers for new models to decrease unscheduled hospitalizations and emergency department visits as well as the uptake of home-based and technology-enabled solutions during the COVID-19 pandemic. A better understanding of these forces helps to clarify the risks and opportunities as new entrants build their programs.
Acute home-based cancer care is a promising tool to complement traditional outpatient clinics, emergency departments, and inpatient hospital-based models of cancer care. New technologies and policies increasingly enable a broader scope of cancer care in the home setting.
癌症患者占因治疗相关症状和疾病进展而接受非计划住院治疗的患者群体的比例很大，且呈上升趋势。这些非计划住院的最初医院接触点通常是急诊科。急诊科和住院医院的传统护理模式已不堪重负，无法扩大规模以满足该群体未来预计增加的需求。因此，需要新的护理模式来填补这一空白。急性居家护理是一种很有前景的工具，有可能为符合条件的患者提供以患者为中心的高效护理。
我们应用了波特五力框架，该框架涉及买家和供应商的议价能力、替代品和新进入者的威胁、行业竞争以及监管这第六种力量，以阐明在急诊科就诊之前或之后促进或挑战采用居家癌症护理转诊模式的因素。探索这一框架有助于深入了解扩大急性居家癌症护理模式的复杂性，并突出医院、急诊科、医生团体以及个体急诊科医生和肿瘤学家等卫生系统在这种新兴护理模式中优化其作用的方式。
我们发现，目前的劳动力短缺以及工作流程、基础设施和监管方面的复杂性构成了重大挑战，除非谨慎应对，否则可能会限制急性居家癌症护理的发展。围绕适当的支付模式和竞争格局仍存在其他不确定性。关键的促进因素包括癌症界和支付方认识到需要新模式来减少非计划住院和急诊科就诊，以及在新冠疫情期间对居家和技术支持解决方案的采用。随着新进入者建立他们的项目，更好地理解这些力量有助于厘清风险和机遇。
急性居家癌症护理是一种很有前景的工具，可补充传统的门诊诊所、急诊科和住院医院的癌症护理模式。新技术和政策越来越能够在居家环境中实现更广泛的癌症护理。
