title: Home management of acute medical complications in cancer patients: a prospective pilot study.
abstract: 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.
  
  
  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.
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain. CFONT@clinic.ub.es.|Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain. CFONT@clinic.ub.es.|Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain. CFONT@clinic.ub.es.
authors.forename: C
authors.initials: C
authors.lastname: Font
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Calderon
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: García-Fernández
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.|Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Arab
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Pineda
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Buxó
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Ayora
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Carreño
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.|Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Pereira
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.|Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Viladot
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Moreno
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gallego
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Hernando
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Creus
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.|Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Barrera
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Alcaraz
authors.affiliation: Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sanchez
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.|Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.|Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain.|Medical School, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Prat
authors.affiliation: Supportive and Palliative Care Unit (SPCU), Medical Oncology Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.|Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Tuca
mesh_terms: 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 / Q000150:complications* / Q000451:nursing / Q000628:therapy*; D010359:Patient Readmission; D018802:Patient-Centered Care; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Alternatives to conventional hospitalization; Home health care, patient-centered care; Home hospitalization in cancer; New models of cancer care