Huntsman Cancer Institute’s oncology hospital-at-home program reduces ED visits, costs

Home-based oncology care for patients with cancer has become a necessity amid the COVID-19 pandemic and has been rapidly adopted since the novel coronavirus outbreak began.

Before the pandemic, Huntsman Cancer Institute (HCI) at University of Utah started offering hospital-level care to patients in their homes through its Huntsman at Home program. Launched in 2018, the program utilizes HCI research and clinical expertise to provide both in-person and remote support, as well as acute-level treatment. It is currently available to Huntsman patients living within a 20-mile radius of the flagship hospital in Salt Lake City.

“Although we had no idea a pandemic would grip the world in 2020 when we started in 2018, Huntsman at Home has been the perfect program to have in place as everyone has scrambled to keep vulnerable and immunosuppressed patients out of the ED and reduce the pressure on hospital beds,” Kathi Mooney, PhD, RN, interim senior director of population sciences at HCI and distinguished professor of nursing at University of Utah, said in an interview with Healio. “Patients and families have been very grateful that Huntsman care is extended to their home and they can be together as families, avoid using health care facilities and not be separated during this time.”

Mooney and colleagues evaluated the program in a study of 367 patients with cancer, including 169 Huntsman at Home participants and 198 patients who qualified for the program but do not live within its service area.

Results, presented at this year’s ASCO20 Virtual Scientific Program, showed evidence of reductions in hospitalization, ED visits and cost with Huntsman at Home vs. usual care.

Mooney spoke with Healio about the study and the benefits of the program for patients with cancer and their loved ones.

Question:What inspired HCI to develop the Huntsman at Home program?

Answer:HCI is committed to advancing and extending its care for patients with cancer and their families. We began looking at how our patients do when they return home between clinic visits. As has been the case with other academic and community center programs, we saw a significant number of ED visits and unplanned hospitalizations. We started to explore programs that could reduce ED use and hospitalization and better meet patients’ needs as they arise at home. As the name suggests, Hospital at Home provides acute-level care akin to care received in the hospital. This approach has been shown to be beneficial for other conditions but had not been evaluated for oncology populations, so we decided to conduct a demonstration project.

Q: How did you evaluate the program in your study?

A: We did not implement it as a research study. Instead, it was a pragmatic trial in which we compared patients sequentially admitted to Huntsman at Home for acute care with a prospective comparison group composed of patients who were eligible for Huntsman at Home care but lived outside the 20-mile service area in the metropolitan area known as the Wasatch Front. Thus far, we have examined the first 15 months of service and the impact on health care utilization through ED visits, hospitalization and costs.

Q: What were your findings in terms of patient outcomes?

A: Based on our propensity-weighted models, we found unplanned hospitalizations were reduced by 58% (P < .001), total length of hospital stay was reduced by 1.2 days (P = .003), ED visits were reduced by 48% (P = .01) and health care costs were 48% lower (P < .001) over the 30 days after enrollment for Huntsman at Home participants compared with the usual care comparison group. There was no evidence of a difference between the groups in ICU admissions, which is to be expected as oncologic emergencies and other patient situations require ICU care as opposed to home or general inpatient hospitalization.

Q: Do patients like the Huntsman at Home program? How might it improve their quality of life?

A: Patients, and importantly their families, appreciate the ability to be at home and receive care that would otherwise require time in the ED or another hospitalization. We are collecting patient and family caregiver data about symptoms and quality of life. Meanwhile, there is evidence from nononcology hospital-at-home programs that care at home instead of hospitalization results in fewer complications, such as hospital-acquired infections, and better maintenance of functional status.

Q: What is the future of this program?

A: We are extending the program beyond a 20-mile radius of the cancer center to evaluate our ability to deliver a program in distant rural communities. We will begin with three counties in southeastern Utah that are a 2 to 4-hour drive from HCI. We will utilize telehealth and remote monitoring combined with on-ground services. Our intention is to examine the scalability throughout our catchment area. We also are extending care in our current service area to admit patients from the ED directly to Huntsman at Home rather than rehospitalization. In addition, we will explore adding home-based services such as selected chemotherapy.

The Hospital at Home model shows real promise for improving care of patients with cancer. Currently, reimbursement for acute-level care at home is insufficient to make the model of care sustainable in our fee-for-service reimbursement environment. New payment models are needed.

For more information:

Kathi Mooney, PhD, RN, can be reached at Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112; email: kathi.mooney@nurs.utah.edu.

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