Acute oncology hospital care at home for post-chemotherapy monitoring.

PURPOSE: Hospitalization at home (HaH) has demonstrated clinical efficacy and improved patient experience in general medicine inpatients. We conducted a quasi-experimental design study of our institution's experience with HaH among patients with multiple myeloma (MM) who received chemotherapy in the hospital and continued their hospitalization at home to complete the rest of their care.

METHODS

We conducted a retrospective chart review of patients with MM who received chemotherapy with dexamethasone, cyclophosphamide, etoposide, and cisplatin with or without bortezomib (DCEP ± V) in the hospital and then continued their hospitalization at home from September 2020 to May 2023. The control cohort was all patients with MM who received DCEP ± V and lived in a zip code excluded from HaH's catchment area. Demographics, length of stay (LOS), 30-day hospital readmissions, and emergency room (ER) visits were extracted from the electronic health record. Primary endpoints were 30-day hospital readmissions and 30-day ER visits. We hypothesized that the HaH cohort was non-inferior to the control cohort.

RESULTS

We identified 24 HaH episodes of care and 62 in the control cohort. Patients enrolled in HaH were younger and more racially diverse. The HaH cohort had a mean total LOS, both hospital plus HaH LOS, of 16 (SD = 4.5) vs. 19.2 (SD = 11.9) days in the control (p = 0.198). Mean HaH LOS was 8.7 days (SD = 3.9), with 208.8 inpatient-bed days saved. Thirty-day hospital admissions as defined by CMS were 0% vs 1.6% in the HaH and control cohort, respectively; the 30-day ER visits had an odds ratio of 1.07 (95% CI = 0.91, 1.26), indicating non-inferiority. Successful HaH admissions occurred for 92% (95% CI = 80.6%, 100%) of care episodes.

CONCLUSION

Successful HaH admissions occurred for 92% of care episodes and provided significant hospital bed days saved. HaH demonstrated non-inferiority for healthcare utilization compared to standard inpatient monitoring, showcasing its potential to optimize resource utilization among this cohort of patients with MM receiving inpatient chemotherapy. These findings support the integration of HaH programs into oncology care and further studies are warranted to expand and refine HaH implementation in this population.