Hospital-at-home oncology care may to save costs and resources in the USA

Abstract

A hospital-at-home programme for adults with cancer appears to reduce unplanned hospitalisations and costs, according to US-based study published in the Journal of Clinical Oncology. The Huntsman at Home trial was a prospective, non-randomised cohort comparison of 367 hospitalised adult patients with cancer conducted between August 2018 and October 2019, with 169 patients consecutively admitted after hospital discharge to the hospital-at-home programme, compared with 198 usual care patients concurrently identified at hospital discharge. Cancer patients admitted with ongoing acute medical or unstable treatment-related symptoms were eligible for the hospital-at-home care if they lived within a particular geographical region, otherwise they were placed in the comparison group. Subsequent care and services depended on the patient presentation. Primary outcomes were the number of unplanned hospitalizations and costs in the 30 days after enrolment. Secondary outcomes were duration of hospital stay, intensive care unit (ICU) admissions, and emergency department (ED) visits in the first 30 days after enrolment. In the first 30 days, the hospital-at-home care reduced the likelihood of unplanned hospitalisations by 55% (odds ratio 0.45; 95% CI 0.29, 0.70; p < 0.001) and lowered healthcare costs by 47% (mean cost ratio 0.53; 95% CI 0.39, 0.72; p < 0.001). In the hospital at home group, total hospital stay days were reduced by 1.1 days (p < 0.01) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI 0.33, 0.92; p < 0.05), but there was no difference in ICU admissions compared with usual care.