Acute oncology care at home for post-chemotherapy monitoring in patients with multiple myeloma.
Authors: Kier Melanie Wain , Truong Tuyet-Trinh , Baldwin Elena , Sheng Tianxiang , Wajnberg Ania , Siu Albert L. , Smith Cardinale B. 
Published: October 2023

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Background: Hospitalization at Home (HaH) has demonstrated clinical efficacy and improved patient experience in general medicine inpatients. Mount Sinai Health System (MSHS) HaH enrolls oncology patients with active disease admitted for acute general medical conditions and for active chemotherapy. We performed a case-control study of our institution’s experience with HaH in multiple myeloma (MM) patients admitted for elective chemotherapy. Methods: We conducted a retrospective chart review of MM patients who received inpatient chemotherapy with dexamethasone, cyclophosphamide, etoposide, and cisplatin with or without bortezomib ((V)-DCEP) and then enrolled in HaH from September 2020 to May 2023. HaH eligibility required meeting established institutional HaH admission criteria, including geographical limitations. The control group were randomly selected MM patients admitted for (V)-DCEP who lived in a zip-code excluded from HaH’s catchment zone. Demographics, social situation, indication for inpatient stay, and HaH admission were extracted from the electronic health record. Primary endpoint was 30-day readmission from final place of discharge. A key secondary endpoint was rate of successful HaH admission, defined as discharge from HaH for complete recovery from the acute condition. Results: Twenty-two patients with MM, with 24 episodes of care, enrolled on HaH for post-chemotherapy monitoring. Our control cohort had 32 patients with 32 episodes of care. In the HaH population, the median age was 57, 73% (n = 16) male, 23% (n = 5) White, 41% (n = 9) Black, 14% (n = 3) Asian, 18% (n = 4) Hispanic, and 55% (n = 12) had either Medicaid or were dual Medicare/Medicaid eligible. In the HaH ineligible group, the median age was 67.5, 63% (n = 20) male, 56% (n = 18) White, 13% (n = 4) Black, 6% (n = 2) Asian, 19% (n = 6) Hispanic, and 32% had either Medicaid or were dual Medicare/Medicaid eligible. In the HaH population, the median inpatient length of stay was 6.5 days compared to 17.5 days in the HaH ineligible cohort (p < 0.001). Mean length of HaH stay was 8.83 days, which saved our health system 212 inpatient-bed days. In the HaH cohort, there were 33% (n= 8) 30-day readmissions, 38% (n = 3) of which were unplanned; similarly, in the HaH ineligible population, there were 38% (n = 12) 30-day readmissions, with 33% of these readmissions unplanned (p = 0.97). Successful HaH admissions occurred for 92% of care episodes. No significant adverse outcomes or issues related to the care delivery or social support. Conclusions: The MSHS HaH program demonstrated safety and feasibility in caring for oncology patients admitted for elective chemotherapy. Hospital readmission frequency was the same across both cohorts. We were able to successfully care for the majority of patients with MM and had significant inpatient bed day savings. HaH should be expanded to other groups of specialized patients, leveraging disease-specific clinical pathways.