Hospital-at-home isn't a new concept, but like so many other areas in healthcare, the COVID-19 pandemic has changed the way it works.
The hospital-at-home model provides hospital-level care within the home environment – leveraging the setting to help reduce costs, support improved outcomes and enhance the patient experience. When it comes to home infusion therapy, the model provides patients convenient access to intravenous or subcutaneous administration of drugs and biologics.
Home infusion has been indispensable during a pandemic that has increased care demands. Patients are no longer required to travel to hospitals, with nurses instead coming to their homes to train and educate patients and caregivers on infusion therapy. Home infusion therapy has even been used to administer monoclonal antibodies in the treatment of COVID-19.
We're on the verge of a new era of the hospital-at-home model, shaped by the COVID-19 pandemic – with home infusion already opening up new possibilities in treating disease and administering patient-centered care.
Home infusion has amazing potential
To prepare for the future of home infusion, it's critical to understand the benefits that this care model offers. Many healthcare decisions are driven by the Triple Aim – lower costs, improved outcomes, and a better patient experience – positioning home infusion as a smart option for many organizations.
Hospital-at-home programs have been found to cut the cost of care by over 30%, according to the Common Wealth Fund, doing exceptionally well in countries with single-payer systems like Canada, England and Israel. In Victoria, Australia, all metropolitan and regional hospitals have hospital-at-home programs, with around 6% of hospital days running through this model.
These programs have supported cost savings and innovative care delivery all while delivering comparable outcomes with fewer complications in comparison to traditional care. In the U.S., however, use has been limited, meaning there is enormous untapped potential for application.
New approaches to treatment
Innovation in home infusion includes treatment of specific diseases and conditions.
Home infusion for treatment of multiple sclerosis is receiving new attention with the study of Natalizumab being administered through four-weekly infusions in the home setting. This hospital-at-home model prioritizes the nurse-patient therapeutic relationship and is responsive to patient needs. The study devised a nine-dimension model of care, centered on patient-centered care at home, covering the following elements:
- The home nursing care provider
- Competency of nurses
- Compliance with standards
- Patients from day infusion clinics
- Handing over patients
- The medical courier
- Safe environments
- Documentation and data collection
- Patient safety and managing adverse events
In the future, models of care like these could be applied to the use of home infusion and treatments of other diseases and conditions.
In the same vein, oncology has seen widespread use of home infusion in response to the pandemic. Over time, chemotherapy delivery has transitioned from the hospital inpatient to outpatient settings, then from specialized community practice to the patient home, in some cases. Because of the COVID-19 pandemic, the definition of "homebound" patients has been temporarily relaxed, opening the door to growth in at-home chemotherapy treatment.
At-home cancer care saves patients the energy-draining effort of driving to a hospital and making their way through parking lots and large buildings. For healthcare organizations, it can be a strong tactic for facilitating patient satisfaction and retention. Even in the face of financial risk, patient safety, and shifting regulations, at-home administration of cancer treatments stands out as a way to not only respond to a pandemic and protect immunocompromised patients but also address a shortage of oncologists and a shift toward patient-centered care.
The future of home infusion faces challenges
Still, with all the benefits of home-infusion care, challenges remain.
This is possibly the biggest barrier to shifting infusion to the home setting. Providers must teach non-clinicians like patients and caregivers to administer medication through technical means. As literacy rates decline, teaching patients becomes more difficult – something that is especially true for patients or caregivers who don't speak English as their primary language.
Adherence can be a challenge with many patients. Often caregivers or patients don't have support, are a sole parent, or are navigating mental health issues or financial challenges. IV nutrition therapy, for example, may frustrate caregivers because of how it impacts their lifestyle.
Medicare treatment of home infusion has been relaxed as a result of the pandemic but its future is uncertain. In many cases, patients may still choose a skilled nursing facility or outpatient facility. Unfortunately, Medicare coverage can be spotty.
As the COVID-19 pandemic continues to shape the future of healthcare, the hospital-at-home model is poised for amazing growth and evolution.