Using the Hospital At Home Model of Care in Oncology

The Hospital at Home model of care is emerging as a promising concept to deliver acute care to patients with cancer outside of hospitals and clinics, especially in the era of COVID-19. In this episode, Kathi Mooney, PhD, RN, a distinguished professor of nursing at the University of Utah and co-leader of the Cancer Control and Population Sciences Program at the Huntsman Cancer Institute, discusses the significant impact of the her institution’s program, the first of its kind in the United States. This new frontier in care offers the oncology care community a chance to rethink its methods and to consider what can be done safely in the home that provides additional support during the cancer experience.

Transcript

ASCO Daily News: Hello and welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. I'm delighted to welcome Dr. Kathi Mooney to the podcast today Dr. Mooney is a distinguished professor of Nursing at the University of Utah and coleader of the Cancer Control and Population Sciences program at the Huntsman Cancer Institute.

Dr. Mooney will discuss the emergence of the hospital at home model of care in the oncology setting and the promise of this concept to deliver acute care to patients, reduce hospitalizations, ER visits, and cost. Dr. Mooney reports no conflicts of interest relating to the issues discussed in this podcast. Full disclosures relating to all Daily News podcasts are available on our episode pages. Dr. Mooney, it's great to have you on the podcast today.

Dr. Kathi Mooney: Thank you for inviting me, Geraldine.

ASCO Daily News: Dr. Mooney, you have done a great deal of research on hospital at home models including your work on the Huntsman at home trial, the first adult oncology hospital at home program in the United States, led by the University of Utah Huntsman Cancer Institute. The results were really impressive and were featured at the ASCO Virtual Scientific Program earlier this year. Can you tell us why you believe this concept could truly move the needle in adopting more innovative patient-centered models of care?

Dr. Kathi Mooney: Yes, thank you. Huntsman at home is a concept that is based on the hospital at home programs that are more widely known internationally in single-payer systems and have been in the United States mostly to support frail elderly at home and so has not previously been evaluated for oncology populations.

At the Huntsman Cancer Institute, we have been interested in providing more models and testing models of care that are in the community. And so we were very interested in whether the hospital at home concept could address some of the challenges we have in oncology care.

As you know, most oncology care is given on an outpatient basis. And so patients are at home for most of their treatment and extended survivor periods of time. And yet we don't have good models to reach out and support patients when they are at home. And as a result, we end up seeing very high levels of emergency department use and rehospitalization.

So we were interested in looking at the hospital at home model for oncology and began that program. And once we had a number of patients in it, we looked at evaluating how it impacted those health care utilization factors we were interested in, both emergency department and rehospitalization. We started by studying 169 patients that had been admitted to our Huntsman at home program and compared them with 198 cancer patients who would have been eligible to be admitted to Huntsman at home but lived outside of our 20-mile service radius.

And we found that indeed, it very much addressed the health care utilization issues and that, in the first 30 days after enrollment in the Huntsman at home or our comparison group, there was a 58% decrease in unplanned hospitalization. And for those who were hospitalized, they had a 1.2 less days of inpatient stay. We also found that it reduced emergency department visits by 48%. And the charges were also 48% less for the patients that were in Huntsman at home.

ASCO Daily News: Well, as you say, the Huntsman at home trial showed that patients can truly benefit from receiving oncology care in their homes. But are there any limitations to this model of care in the oncology setting in particular? What are some of the challenges that typically arise for oncology clinicians providing care at home?

Dr. Kathi Mooney: Well, one of the things is to really understand the care needs of oncology patients at home. And what we have found is that there is an initial acute care event for which Huntsman at home gets involved. And then once the patient is stabilized, then not too long afterwards, they may have an exacerbation of the problems that they were experiencing or new problems.

So one of the things in the model for oncology care is how we identify and give high-intensity care f...