Creating and Validating a Predictive Model for Suitability of Hospital at Home for Patients With Solid-Tumor Malignancies

2021 ◽  
pp. OP.20.00663
Author(s):  
Kevin Chen ◽  
Keval Desai ◽  
Soundari Sureshanand ◽  
Kerin Adelson ◽  
Jeremy I. Schwartz ◽  
...  
Keyword(s):  
Predictive Model ◽  
Solid Tumor ◽  
Hospital Admissions ◽  
Tube Placement ◽  
Hospital Death ◽  
Secondary Malignancy ◽  
Admission Source ◽  
Laboratory Test Results ◽  
Hospital At Home ◽  
At Home

PURPOSE: Hospital at home (HaH) is a means of providing inpatient-level care at home. Selection of admissions potentially suitable for HaH in oncology is not well studied. We sought to create a predictive model for identifying admissions of patients with cancer, specifically solid-tumor malignancies, potentially suitable for HaH. METHODS: In this observational study, we analyzed admissions of patients with solid-tumor malignancies and unplanned admissions (January 1, 2015, to June 12, 2019) at an academic, urban cancer hospital. Potential suitability for HaH was the primary outcome. Admissions were considered potentially suitable if they did not involve escalation of care, rapid response evaluation, in-hospital death, telemetry, surgical procedure, consultation to a procedural service, advanced imaging, transfusion, restraints, and nasogastric tube placement. Admission source, patient demographics, vital signs, laboratory test results, comorbidities, admission and active cancer diagnoses, and recent hospital utilization were included as candidate variables in a multivariable logistic regression model. RESULTS: Of 3,322 admissions, 905 (27.2%) patients were potentially suitable for HaH. After variable selection in the derivation cohort (n = 1,097), thirteen factors predicted potential suitability: admission source; temperature and respiratory rate at presentation; hemoglobin; breast cancer, GI cancer, or malignancy of secondary or ill-defined origin; admission for genitourinary, musculoskeletal, or neurologic symptoms, intestinal obstruction or ileus, or evaluation of secondary malignancy; and emergency department visit in prior 90 days. Model c-statistics were 0.71 (95% CI, 0.68 to 0.75) and 0.63 (0.59 to 0.67) in the derivation and validation (n = 1,095) cohorts. CONCLUSION: Hospital admissions of patients potentially suitable for HaH may be identifiable using data available at admission.

Site of death, place of care, and burdensome transitions among patients with advanced solid tumor malignancies or leukemia between 2000 and 2010.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 144-144
Author(s):  
Elizabeth Horn Prsic ◽  
Joan M. Teno ◽  
Pedro Gozalo
Keyword(s):  
Solid Tumor ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Hospital Death ◽  
Fee For Service ◽  
Advanced Solid Tumor ◽  
Billing Data ◽  
Early Palliative Care ◽  
Adjusted Rate ◽  
Over Time

144 Background: Early palliative care has been associated with improved outcomes in oncology patients. However, there is limited data on end-of-life (EOL) care in hematology patients over time. We describe site of death, place of care, and transitions at the EOL among leukemia and advanced solid tumor malignancy (ASTM) patients. Methods: Retrospective cohort study of fee-for-service Medicare beneficiaries 66 years and older who died in 2000 (n = 40,805) and 2010 (n = 43,547) with leukemia or advanced lung, colorectal, or pancreatic cancer. Based on Medicare billing data, we identified site of death, place of care, and burdensome transitions (BT). Examples of BT include multiple hospital admissions for expected complications, referral to hospice in the last 3 days of life (DOL), and EOL transfers. Results: The rate of acute hospital death decreased for leukemia and ASTM patients over time (adjusted rate decreases 8.4% in leukemia vs. 8.2% in ASTM, p < .001). However, acute hospital death was more likely in leukemia patients in 2010 (adjusted rates 35.8% vs. 19.0% in ASTM, p < .001). Intensive care unit (ICU) admission in the last 30 DOL increased in both groups, and was more likely in leukemia patients in 2010 (adjusted rates 34.2% vs. 23.4% in ASTM, p < .001). Transitions in the last 3 DOL increased over time, and occurred more frequently in leukemia patients compared to ASTM patients in 2010 (adjusted rates 24.5% vs. 19.0% in ASTM, p < .001). Multiple admissions for expected complications increased similarly for patients in both groups over time (adjusted rate increases 2.7% in leukemia vs. 2.9% in ASTM, p < .001). There was a striking increase in freestanding hospice inpatient unit care before death over time (increasing from 4.5% to 11.5% in leukemia and 7.5% to 15.9% in ASTM). Conclusions: Between 2000 and 2010, the rate of acute hospital death decreased in both leukemia and ASTM patients. However, there were increased rates of ICU and multiple admissions for expected complications in both groups, particularly in leukemia patients compared to ASTM patients. A similar increase was also observed in the use of freestanding hospice units before death for both groups.

696 Hospital at home: descriptive study of patients with chronic heart failure (CrHF) attended at home

2006 ◽  
Vol 5 (1) ◽  
pp. 158-159
Author(s):  
J GUILLAMONT ◽  
A SOLE ◽  
S GONZALEZ ◽  
A PEREZITURRIAGA ◽  
C DAVILA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Descriptive Study ◽  
Hospital At Home ◽  
At Home

scholarly journals Comparison of Cancer Patients to Non-Cancer Patients among COVID-19 Inpatients at a National Level

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1436
Author(s):  
Alain Bernard ◽  
Jonathan Cottenet ◽  
Philippe Bonniaud ◽  
Lionel Piroth ◽  
Patrick Arveux ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Mortality Risk ◽  
Hospital Admissions ◽  
National Level ◽  
Administrative Database ◽  
Hospital Death ◽  
Solid Cancer ◽  
Hematological Cancer ◽  
Risk Of Death

(1) Background: Several smaller studies have shown that COVID-19 patients with cancer are at a significantly higher risk of death. Our objective was to compare patients hospitalized for COVID-19 with cancer to those without cancer using national data and to study the effect of cancer on the risk of hospital death and intensive care unit (ICU) admission. (2) Methods: All patients hospitalized in France for COVID-19 in March–April 2020 were included from the French national administrative database, which contains discharge summaries for all hospital admissions in France. Cancer patients were identified within this population. The effect of cancer was estimated with logistic regression, adjusting for age, sex and comorbidities. (3) Results: Among the 89,530 COVID-19 patients, we identified 6201 cancer patients (6.9%). These patients were older and were more likely to be men and to have complications (acute respiratory and kidney failure, venous thrombosis, atrial fibrillation) than those without cancer. In patients with hematological cancer, admission to ICU was significantly more frequent (24.8%) than patients without cancer (16.4%) (p < 0.01). Solid cancer patients without metastasis had a significantly higher mortality risk than patients without cancer (aOR = 1.4 [1.3–1.5]), and the difference was even more marked for metastatic solid cancer patients (aOR = 3.6 [3.2–4.0]). Compared to patients with colorectal cancer, patients with lung cancer, digestive cancer (excluding colorectal cancer) and hematological cancer had a higher mortality risk (aOR = 2.0 [1.6–2.6], 1.6 [1.3–2.1] and 1.4 [1.1–1.8], respectively). (4) Conclusions: This study shows that, in France, patients with COVID-19 and cancer have a two-fold risk of death when compared to COVID-19 patients without cancer. We suggest the need to reorganize facilities to prevent the contamination of patients being treated for cancer, similar to what is already being done in some countries.

The unique role of the social worker within the Hospital at Home care delivery team

2021 ◽  
pp. 1-15
Author(s):  
Helena Ross ◽  
Ryan Dritz ◽  
Barbara Morano ◽  
Sara Lubetsky ◽  
Pamela Saenger ◽  
...  
Keyword(s):  
Home Care ◽  
Social Worker ◽  
Care Delivery ◽  
Unique Role ◽  
The Social ◽  
Hospital At Home ◽  
At Home

High-Tech Home Care – von der Intensivstation ins Wohnzimmer

2009 ◽  
Vol 17 (4) ◽  
pp. 11-13
Author(s):  
Michael Ewers
Keyword(s):  
Home Care ◽  
High Tech ◽  
Hospital At Home ◽  
At Home

EinleitungPatienten in kritischen Gesundheitssituationen und solche mit therapeutisch-technischem Unterstützungsbedarf sollen auch in Deutschland vermehrt im häuslichen Umfeld versorgt werden. Die Voraussetzungen der als High-Tech Home Care (HTHC) oder Hospital-at-Home (H@H) international bekannten Versorgungsform und die mit dem Transfer der Medizintechnik von der Intensivstation ins Wohnzimmer verbundenen (un-)erwünschten Effekte – besonders für die Nutzer – erfahren aber noch selten die notwendige Aufmerksamkeit.

Sign in / Sign up

Export Citation Format

Share Document