In April, Somerville, Mass.-based Mass General Brigham added oncology care to its Home Hospital program to alleviate capacity issues within acute care facilities, while also providing a way for cancer patients to benefit from remaining close to their support systems at home.
The service is overseen by Heather O’Sullivan, MS, APRN, president and COO of Mass General Brigham Healthcare at Home, and Thomas Roberts, MD, clinical director of oncology services for the program.
They spoke to Becker’s about how the expansion was operationalized and what industry leaders should consider when rolling out cancer care within their own hospital-at-home programs.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What prompted Mass General Brigham to expand its Home Hospital program to include oncology care?
Dr. Thomas Roberts: Two things prompted us to launch the program. One is from a patient care perspective: It’s kind of the logical endpoint of a lot of this work to try to bring patients closer to home. Becker’s readers are probably familiar with some of the fairly established literature around time toxicity and financial toxicity within cancer care. Admissions are a huge part of that, especially for patients with solid tumors who have unplanned admissions and are near the end of their life. Allowing those patients to spend more of that time at home is a really important part of their care.
The second is from a systems’ perspective regarding capacity. The reality is — despite our best efforts to keep patients out of the hospital — 365 days a year we have more patients with cancer in need of admission than there are beds available in the hospital. Hospital at Home is a way to expand our inpatient services that we can provide without actually constructing a building with more beds.
Q: How does the Home Hospital oncology expansion support Mass General’s long-term strategy and vision?
Heather O’Sullivan: This clinical expansion opens another pathway for patients to receive the high-quality, well-coordinated care that Home Hospital provides, while also helping to alleviate the capacity crisis at our traditional brick-and-mortar facilities. Additionally, it aligns with the vision of the Mass General Brigham Cancer Institute to expand leading-edge cancer care beyond large academic hospitals so that patients can access world-class care near or in their homes.
Q: What operational changes were required to support the integration of oncology care into the Home Hospital model?
TR: It’s important to understand that the vast majority of what most oncologists do, including myself, is supportive care. We give patients these really toxic treatments for these terrible diseases. We’re managing symptoms of the disease and the treatments that we provide.
The two sorts of broad stroke things that are different about caring for patients with cancer in home hospital are: one, the baseline level of acuity is a lot higher, and second, you’re caring for patients as part of a continuum of care, as opposed to a single episode of care.
The integration of the inpatient experience with the outpatient experience was something that we spent a lot of time thinking about. When we designed it, we thought it was really important to bring in people from the Cancer Center to coordinate care for these patients.
There were two areas that we had to spend a good bit of time on: One was expanding capabilities, which is an ongoing process. Tube feedings and port management as well as laryngectomy stoma and tracheostomy management and transfusions in the future. We first had to build comfort among the nursing population and develop safety protocols to ensure we’re providing the right services for the right patients with the right measures in place.
And the other is working with the teams that are actually physically going in the home and talking about what it means to care for patients at home. The majority of our patients are near the end of their lives and every day in the hospital is a day they otherwise don’t have at home. We discuss the soft skills needed for navigating some of those conversations. This sort of interaction with end-of-life care and death is not necessarily something that all providers have experience with, so introducing it as a routine part of the clinical practice requires support. I’ve certainly been spending some time doing debriefs with nurses and with APPs to make sure we’re appropriately processing these experiences.
Q: What role does technology play in MGB’s Home Hospital program in general and for oncology?
HO: The future of healthcare is at home, and Home Hospital is one of the most innovative models delivering hospital-level care to patients. This transformative, technology-enabled approach to acute care improves patient satisfaction and clinical outcomes. Our suite of remote patient monitoring devices keeps our patients connected while at home and gives our clinicians the confidence to recommend Home Hospital as the preferred treatment plan. This improves the experience for patients receiving Home Hospital care as well as for the multi-dimensional care team that provides it.
TR: At the moment, we’re using the same technology for cancer patients that’s used for all home hospital patients. We don’t have any sort of additional technology layered on top, but the technology is key. Without the technology, we wouldn’t be able to do it. Utilizing technology to coordinate virtual visits and get continuous vitals has been key. Being able to do point-of-care i-STAT lab testing in the home has also been helpful for patients.
Q: What advice would you offer to other health systems considering launching or expanding home-based oncology services?
HO: Our ability to quickly launch and begin scaling our Home Hospital oncology service relied on having an established Home Hospital capable of managing increasingly complex medical and post-operative surgical patients, along with a highly collaborative team from Mass General Brigham Cancer Institute specially trained to support oncology patients and coordinate seamlessly with our Home Hospital clinicians.
TR: Cancer patients are a different population with different needs which will require different capabilities. Both the sort of hard capabilities that need to be developed and the sort of softer competencies that need to be worked on and supported.
One thing I struggle with as an outpatient oncologist is having a large population of patients who are sick enough that they meet inpatient criteria every single day of their lives. If they show up in the emergency room, they’re 100% going to be admitted to the hospital. It can be really challenging and resource-intensive to take care of them in the outpatient setting.We provide this care to keep them at home because it’s important to the patients but also for its effect on physicians.
To a person, every oncologist I’ve asked about their experience when their patients were admitted to home hospital have felt it was a really great experience. That’s a big reason why health systems should be thinking about integrating this care model.
Q: What leadership insights or organizational shifts have been most critical in scaling the Home Hospital model to support complex patient populations like those in oncology? How do you envision this model evolving across other specialties in the future?
HO: Since its inception, Mass General Brigham’s Home Hospital has steadily expanded its services and operational capabilities needed to safely scale this care model. Over the years, Home Hospital has expanded support and services beyond common medical diagnosis to include post-surgical cases, including patients recovering from colorectal, intra-abdominal and spinal procedures, as well as postpartum patients with hypertension and, most recently oncology patients. As we continue to grow, we identify patients who would significantly benefit from acute care at home, thus expanding patient access and ensuring the highest quality clinical treatment. Looking ahead, we see the Home Hospital model evolving across other specialties by leveraging successful strategies, promoting collaboration and adapting to patient needs.
