ideasIdea
Oncology hospital-at-home with remote monitoring for toxicity
Manage fevers, dehydration and other treatment side-effects at home with visiting nurses, wearables and video, instead of admitting people to hospital wards.
Hospital-at-home programmes for medical conditions reduce cost and complications with equal or better outcomes. Oncology pilots (including for neutropenic fever in low-risk patients and post-chemotherapy support) show feasibility. The proposal is a scaled model combining patient-reported outcomes, wearable vital signs, home intravenous therapy and same-day nurse response, integrated with the oncology team, evaluated for safety and patient preference.
Hypothesis
Hospital-at-home reduces inpatient bed-days for toxicity by a third with no increase in mortality or intensive care admission and higher patient-reported satisfaction.
Rationale
Most toxicity admissions are for monitoring and supportive therapy that do not need a ward; being at home preserves function and reduces hospital-acquired harm.
What would test it
Randomised trial of hospital-at-home versus admission for defined toxicity presentations in patients meeting safety criteria; primary endpoint composite of death, ICU admission and readmission at 30 days.
Maturity
early clinical
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.