Home management of acute medical complications in cancer patients: a prospective pilot study.
BACKGROUND
The development of reliable alternatives to conventional hospitalization in patients with cancer would have great clinical and economical value. The aim of the present study was to assess the feasibility of a home-based nursing intervention model as a safe alternative for the management of acute medical complications in cancer patients who would otherwise require conventional hospitalization.


PATIENTS AND METHODS
From October 2013 to October 2014, we prospectively evaluated the outcomes of consecutive acute medical episodes treated at home under the home-based intervention program named the Bridge Project (BP). Episodes were classified as "avoided hospitalization in outpatients" (AHO) vs. "reduced hospitalization in inpatients" (RHI). The primary end-point was to assess the rate and causes of BP intervention failure (unplanned hospital readmission or death).


RESULTS
Two hundred and forty-six consecutive episodes (52 % AHO and 48 % RHI) involving 203 patients (55 % male; mean age 63 years) were enrolled. The main conditions managed at home were non-neutropenic infections (40 %), febrile neutropenia (20 %), and cancer-related complications (28 %). The median duration of the BP intervention was 5 days (range 1-16 days). No deaths were reported at home. Unplanned hospital readmissions occurred in 9 % of episodes (14 % in AHO vs. 4 % in RHI; p = 0.001). Five of the 22 readmitted patients (22.7 % of the BP failures; 2.5 % of the whole series) died during hospitalization. The BP intervention burden was 1353 days, representing a potential saving of 14 % of days of hospitalization during the study period.


CONCLUSIONS
The BP is a safe intervention which can potentially avoid or reduce the length of hospitalization in selected cancer patients with acute medical complications. Our findings support further development of innovative home-based clinical approaches to promote potentially avoidable hospitalization in this setting.
['Font|C|C|', 'Fernández-Avilés|F|F|', 'Calderon|C|C|', 'García-Fernández|T|T|', 'Arab|N|N|', 'Pineda|E|E|', 'Buxó|E|E|', 'Ayora|P|P|', 'Carreño|M|M|', 'Pereira|V|V|', 'Viladot|M|M|', 'Moreno|C|C|', 'Gallego|C|C|', 'Hernando|A|A|', 'Creus|N|N|', 'Barrera|C|C|', 'Alcaraz|R|R|', 'Sanchez|J|J|', 'Prat|A|A|', 'Tuca|A|A|']
D000208:Acute Disease D000368:Aged D000369:Aged, 80 and over D005240:Feasibility Studies D005260:Female D006699:Home Care Services D006801:Humans D008297:Male D008875:Middle Aged D009369:Neoplasms D010359:Patient Readmission D018802:Patient-Centered Care D010865:Pilot Projects D011446:Prospective Studies D016896:Treatment Outcome
Alternatives to conventional hospitalization Home health care, patient-centered care Home hospitalization in cancer New models of cancer care