Rural Access to the Cancer Hospital at Home Care Model

SummaryRural residents being treated for cancer face multiple barriers to appropriate care because they live far from the specialized cancer care facilities where they receive their treatment, and the necessary travel is arduous, time consuming, and often prohibitively expensive. At home, symptoms from treatment or progressive disease fluctuate, leaving patients without local specialty resources to respond to these changes. To address this disparity, Huntsman Cancer Institute (HCI) implemented Rural Huntsman at Home (Rural HH), adapted from its urban hospital-at-home program, to provide acute and subacute care at home to patients in isolated areas at a distance from HCI. Using a nurse practitioner care delivery model and multidisciplinary team and drawing from the electronic health record, Rural HH used a population-based strategy to monitor the clinical trajectory and symptom burden of patients undergoing cancer treatment within its rural service areas and expanded the use of telehealth and remote patient monitoring technology. More than 50% of acute-care episodes were able to be treated in the home, averting ED use or hospitalization. In addition, the Rural HH clinical team estimated that 72% of patients who were monitored through the subacute program had early signs of symptom deterioration that without Rural HH management, would likely have resulted in acute escalations and ED visits or hospitalizations. Paired with acute episode care in the home, subacute symptom reduction through rural hospital-at-home programs holds great promise as a preventive strategy to decrease acute escalations, improve patient and family quality of life, decrease unplanned health care utilization, and decrease travel demands for symptom care.