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，情感和金融伯伦斯特别要求接受的老年癌症患者 自体造血干细胞移植（HCT），需要延长住院或每日访问 门诊诊所3-4周，护理人员将24/7全天候提供。 Home HCT是一种新型策略，提供 密集支持，综合护理管理和个性化干预措施，侧重于帮助患者和 护理人员在家中管理护理，有可能提高患者生活质量，减少照料者的压力和 降低医疗保健利用和成本。 在我们成功的第一阶段Home HCT飞行员的基础上，我们提出了Home VS的随机2阶段试验。 标准自体HCT。与标准的基于医院的护理相反，家庭HCT的提供者每日房屋 呼叫，与患者和照顾者一起制定个性化的治疗计划，以促进管理 在家中的HCT并发症。家庭护理可能具有许多优势，特别是对于老年人， HOME HCT可能会导致更好的患者生活质量（留在正常环境中），更好的活动（更容易 比拥挤的医院走廊在家里或附近走来走去），更好的营养（家庭与医院 食物），更好的睡眠（家庭与医院床）等。此外，物流非常简化 不需要每天开车来驾驶，这可能会减轻护理人员的压力，焦虑和疲劳，从而减轻 改善护理人员的生活质量；此外，这可以免费提供护理人员，为患者提供更多支持， 进一步改善患者的预后。另外，增加了信心和能够照顾患者的能力 可能会减少急诊室的访问和再入院。尽管前期人员配备成本可能会更高，但总体而言 可以通过减少并发症并使患者远离医院来降低卫生系统成本。 我们的第一个目的是确定家庭HCT对患者健康，生活质量和功能的影响， 包括整体生活质量（事实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，自我效能感，自付费用，并恢复 我们的第二个目的是确定家庭HCT对护理人员福祉的影响，包括许多 以上措施以及护理人员应变（护理人员菌株指数，主要终点），燃烧和满意度。 定性研究都是两种旨在更好地了解家庭HCT哪些方面最有影响力的一部分 并可能应用于其他疾病；这对于计划未来的研究和实施特别重要。 第三个目的是确定HOME HCT对医疗保健利用结果（例如再入院）的影响， 住院时间和整体成本。长期目标是改善患者和护理人员的结果 通过支持他们在家的护理；将患者留在家中，外出医院可能会降低成本。这 这项研究的成功可能是减少护理人员伯恩并保持患者的其他策略的模型 在家里提供优质的护理，在医院离开医院。