Home-based Autologous Hematopoietic Stem Cell Transplantation to Improve Outcomes and Decrease Costs

家庭自体造血干细胞移植可改善结果并降低成本

• 批准号: 10368106
• 负责人: Anthony Sung
• 金额: $ 62.99万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10368106
• 关键词: Ambulatory Care Facilities; Anecdotes; Antibiotics; Anxiety; Autologous; Back; Blood Transfusion; Cancer Patient; Caregiver Burden; Caregiver support; Caregiver well-being; Caregivers; Caring; Crowding; Custom; Deterioration; Disease; Disease remission; Elderly; Emergency department visit; Emotional; Environment; Family; Fatigue; Financial Hardship; Food; Future; Geographic Locations; Health; Health Care Costs; Health Expenditures; Health Personnel; Health system; Hematopoietic Stem Cell Transplantation; Home; Home environment; Home visitation; Hospitalization; Hospitals; Institution; Intervention; Interview; Intravenous; Length of Stay; Logistics; Malignant Neoplasms; Measures; Mediating; Mental Depression; Mental Health; Modeling; National Center for Advancing Translational Sciences; Neighborhoods; Nutritional status; Outcome; Outpatients; Patient Care; Patient-Focused Outcomes; Patients; Phase; Physical Function; Population; Provider; Quality of Care; Quality of life; Randomized; Reporting; Resources; Self Efficacy; Sleep; Social support; Stress; Suggestion; Symptoms; Testing; Transplant Recipients; Transplantation; Travel; Visit; Walking; Work; arm; base; care providers; caregiver interventions; caregiver strain; clinical practice; cognitive function; cost; efficacy evaluation; experience; financial toxicity; health care service utilization; hospital bed; hospital readmission; improved; improved outcome; indexing; individual patient; individualized medicine; innovation; insight; novel strategies; nutrition; patient home care; phase II trial; phase III trial; primary endpoint; programs; safety and feasibility; satisfaction; success; treatment planning

Physical, emotional, and financial burdens are especially demanding for older cancer patients undergoing autologous hematopoietic stem cell transplant (HCT), which requires prolonged hospitalizations or daily visits in outpatient clinics for 3-4 weeks and caregivers to be available 24/7. Home HCT is a novel strategy that provides intensive support, integrated care management, and individualized interventions focused on helping patients and caregivers manage care at home, with the potential to improve patient quality of life, reduce caregiver strain, and decrease healthcare utilization and costs. Building on our successful phase 1 home HCT pilot, we propose a randomized phase 2 trial of home vs. standard autologous HCT. In contrast to standard hospital-based care, providers of home HCT make daily house calls, working with patients and caregivers to form individualized treatment plans that facilitate management of HCT complications at home. Home-based care may have many advantages, particularly for older adults, and home HCT may result in better patient quality of life (remaining in their normal environment), better activity (easier to walk around the home or neighborhood than crowded hospital corridors), better nutrition (home vs. hospital food), better sleep (home vs. hospital bed), etc. Additionally, logistics are vastly simplified for caregivers who don’t need to drive back-and-forth daily, which could decrease caregiver strain, anxiety, and fatigue, thereby improving caregiver quality of life; in addition, this may free caregivers to provide more support for patients, further improving patient outcomes. In addition, increased confidence and ability to take care of patients at home may reduce emergency room visits and readmissions. Though upfront staffing costs may be higher, overall health system costs may be lowered by reducing complications and keeping patients out of the hospital. Our first aim is to determine the impact of home HCT on patient health, quality of life and function, including overall quality of life (FACT-BMT, primary endpoint), symptoms, physical function, cognitive function, fatigue, sleep, nutritional status, mental health, social support, self-efficacy, out-of-pocket costs, and return to work. Our second aim is to determine the impact of home HCT on caregiver well-being, including many of the above measures as well as caregiver strain (caregiver strain index, primary endpoint), burden, and satisfaction. Qualitative studies are part of both aims to better understand which aspects of home HCT are most impactful and may be applied to other diseases; this is especially important for planning future studies and implementation. The third aim is to determine the effect home HCT on healthcare utilization outcomes such as readmissions, length of stay, and overall costs. The long-term objectives are to improve outcomes for patients and caregivers by supporting their care at home; keeping patients at home and out of the hospital may in turn reduce costs. The success of this study may serve as a model for other strategies to reduce caregiver burden and keep patients out of the hospital by delivering quality care at home.

身体，情感和经济负担对于接受手术的老年癌症患者来说尤其苛刻。 自体造血干细胞移植（HCT），这需要长期住院治疗或每天就诊， 门诊3-4周，护理人员24/7提供服务。家庭HCT是一种新的策略， 强化支持、综合护理管理和个性化干预，重点是帮助患者， 护理人员在家中管理护理，有可能改善患者的生活质量，减少护理人员的压力， 降低医疗保健利用率和成本。 基于我们成功的1期家庭HCT试点，我们提出了一项随机的2期家庭与家庭HCT试验。 标准自体血细胞比容。与标准的医院护理相比，家庭HCT的提供者每天都在 电话，与患者和护理人员合作，制定个性化的治疗计划， HCT并发症在家里。家庭护理可能有许多优点，特别是对老年人来说， 家庭HCT可以导致更好的患者生活质量（保持在他们的正常环境中）、更好的活动（更容易 在家里或附近散步比拥挤的医院走廊），更好的营养（家庭与医院 食物）、更好的睡眠（在家与医院病床）等。此外， 不需要每天来回开车，这可以减少护理人员的压力，焦虑和疲劳，从而 提高护理人员的生活质量;此外，这可以使护理人员自由地为患者提供更多的支持， 进一步改善患者的预后。此外，增加了在家照顾病人的信心和能力 可以减少急诊室就诊和再入院。虽然前期的员工成本可能会更高，但总体而言， 通过减少并发症和使病人不住院，可以降低卫生系统的费用。 我们的首要目标是确定家庭HCT对患者健康、生活质量和功能的影响， 包括总体生活质量（FACT-BMT，主要终点）、症状、身体功能、认知功能， 疲劳、睡眠、营养状况、心理健康、社会支持、自我效能、自付费用和返回 工作我们的第二个目标是确定家庭HCT对护理人员健康的影响，包括许多 上述措施以及照顾者压力（照顾者压力指数，主要终点），负担和满意度。 定性研究是这两个目标的一部分，以更好地了解家庭HCT的哪些方面最有影响力 并可能适用于其他疾病;这对规划未来的研究和实施尤为重要。 第三个目的是确定家庭HCT对医疗保健利用结果的影响，例如再入院， 停留时间和总费用。长期目标是改善患者和护理人员的结局 通过支持他们在家里的护理;让病人呆在家里，不在医院，反过来可以降低成本。的 这项研究的成功可以作为其他策略的模型，以减轻照顾者的负担，并保持病人 通过在家中提供高质量的护理，