Examples of this phenomenon include the adoption of telehealth clinic visits, home hospital programs, and increased access to home infusion services. However, the traditional ED-to-hospital pathway has in some cases exacerbated congestion and cost in US health care, leading some systems and communities to decentralize and distribute care to patients’ homes. Today, there are over 5000 EDs in the United States (US), roughly 1100 of which are associated with academic teaching hospitals and 1300 of which provide critical access to essential medical care in areas where there otherwise would be none. Unlike most clinics, EDs provide around-the-clock access to clinicians whenever the need may arise.
Correspondingly, emergency departments (EDs) arose as the hospital-based point of entry for rapid access to diagnostics and treatments. Since the 1950s, as diagnostic and treatment technologies advanced, doctor’s tools no longer fit into a neatly packed black bag but, rather, are concentrated in health centers, clinics, and hospitals. Over the course of the twentieth century, the site of medical treatment transitioned away from individuals’ homes and into centralized centers for medical care. New technologies and policies increasingly enable a broader scope of cancer care in the home setting. ConclusionsĪcute home-based cancer care is a promising tool to complement traditional outpatient clinics, emergency departments, and inpatient hospital-based models of cancer care. A better understanding of these forces helps to clarify the risks and opportunities as new entrants build their programs. Key promoting factors include the recognized need in the cancer community and among payers for new models to decrease unscheduled hospitalizations and emergency department visits as well as the uptake of home-based and technology-enabled solutions during the COVID-19 pandemic. Additional uncertainties persist around appropriate payment models and the competitive landscape.
We found that current workforce shortages, as well as workflow, infrastructure, and regulatory complexities, pose major challenges that unless carefully addressed may restrict the growth of acute home-based cancer care.
Exploring this framework provides insights into the complexities of scaling an acute home-based cancer care model and highlights ways for health systems including hospitals, emergency departments, physician groups, and individual emergency physicians and oncologists to optimize their roles in this emerging model of care.
#Best care for follow ed visits plus
We applied Porter’s Five Forces framework that addresses the bargaining power of buyers and suppliers, threat of substitutes and new entrants, and industry rivalries plus the sixth force of regulation to clarify the factors that will promote or challenge the adoption of a home-based cancer care referral model before or following emergency department visits. Acute home-based care is a promising tool potentially providing patient-centric, efficient care to eligible patients. New models of care are necessary to address this gap. Traditional models of emergency department and inpatient hospital-based care are saturated and incapable of scaling to accommodate the future, increased needs projected for this population. The initial hospital-based touchpoint for these unscheduled hospitalizations is often the emergency department. Patients with cancer constitute a large and increasing segment of patients who receive unscheduled hospital-based care due to treatment-related symptoms and disease progression.
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