Abstract
System and patient-based barriers lead to the inability of individuals to access appropriate treatment and oncologic care. Establishment of a homebound hematopoietic stem cell transplantation (HSCT) program promotes increased access to care and decreased patient disparity. This research initiative seeks to expand care of a patient treated with HSCT into the home setting. The primary objective of the protocol is to assess the feasibility of performing all post-HSCT care for select patients with a diagnosis of multiple myeloma in New York City in the home environment. The program is considered feasible if no more than 10/15 patients are readmitted to the hospital within 21 days of transplantation. Secondary objectives include assessment of adverse events, patient and caregiver satisfaction, and accuracy of telemedicine.
We report on the creation and establishment of a homebound HSCT program within a single academic medical center with an emphasis on the role of the advanced practice provider (APP) and registered nurse. This homebound program is the second within the US, and the first within an urban landscape that employs services by providers who are not a part of a home health licensed agency or institution. Recognition that analysis of early experiences can inform subsequent efforts by other institutions in developing like programs merits a comprehensive process review of the homebound initiative, specifically the role of the APP and RN within the context of the provision of care within a home environment. Identification of infrastructure and research needs and the outline of an implementation framework with standard operating guidelines for providers will assist in the introduction of similar programs within other institutions. Barriers to program establishment included limited evidence as to both the clinical and financial effectiveness of a homebound program, reimbursement issues with third-party payers, increased burden to providers within an institution not licensed as a home health agency, and legal counsel due to individual state regulations surrounding home care. Review of the training offered to providers will allow for insight and eventual establishment of best practices related to the training of providers within a homebound stem cell transplantation program. As the majority of program establishment and implementation is completed in isolation, the need for an openly accessible knowledge base and structured collaboration surrounding sharing of best practices regarding the provision of oncologic care in the home environment is evident.
