Model Finds At-Home Cancer Care Reduces ED Visits and Costs

Researchers from the Huntsman Cancer Institute (HCI) at the University of Utah (U of U) evaluated the feasibility and benefit of implementing at-home acute care for patients with cancer.

Findings from this study were published in the Journal of Clinical Oncology.

To test their care model, named Huntsman at Home (HH), the researchers enrolled 367 patients being treated for cancer at HCI. They compared 169 patients consecutively discharged to the at-home care program with 198 patients who received usual in-patient care. Groups had similar enrollment criteria, however patients in the usual care group lived outside the HH service area.

“Acute cancer care in the home had not previously been evaluated,” said Kathleen Mooney, PhD, RN, Huntsman at Home research director and distinguished professor of nursing at U of U, via a press release. “We sought to create a model that extended the compassionate care of HCI to provide services in a patient’s home that otherwise might require urgent or emergency care or a longer hospitalization to resolve. Yet we also knew it had to be sustainable and would require new insurance reimbursement models. Therefore, we evaluated our HH program on health care utilization and costs to determine the value added by the acute care model.”

The primary endpoints were incidence of unplanned hospitalizations and costs over 30 days. Secondary endpoints include hospital length of stay, intensive care (ICU) admissions, and emergency department (ED) admissions.

Patients in the at-home care group had a 55% reduction in risk of unplanned hospitalizations compared to the control group (odds ratio [OR] 0.45; 95% confidence interval [CI] 0.29–0.70; P<0.001) and a 47% reduction in costs (mean cost ratio 0.53; 95% CI 0.33 – 0.92; P=0.022). At-home care was also associated in an average reduction of 1.1 days in the hospital (P=0.004) and 45% reduced risk of ED visits (OR 0.55; 95% CI 0.33–0.92; P=0.022). The groups had comparable rates of ICU admissions.

“We found that emergency department visits and hospitalizations were approximately cut in half for patients who participated in Huntsman at Home,” said Dr. Mooney.

In conclusion, the authors wrote, “A hospital-at-home model of acute care shows promise for reducing unplanned health care utilization and costs in cancer care delivery. This evaluation supports further consideration and study of this innovative model of care for oncology.”