September/October 2021
The first step in collecting “Status at Discharge” data was to determine the home infusion discharge variables and their definitions. A research team comprised of professionals with experience in home infusion nursing, pharmacy, and administration was established. After much discussion and a review of the literature, the research team determined that the following “Status at Discharge” variables would be used when collecting the data. Definitions for each variable were written and included in the Data Entry Guide, which was given to each provider location that participated in the study.
Status at Dischage |
Description |
---|---|
Therapy completed
|
Applies when a physician discontinues the home infusion therapy because the patient has achieved sufficient clinical improvement and/or met the goals in the plan of care.
|
Patient expired
|
Patient expired
|
Unplanned hospitalization
|
When a patient requires an unplanned inpatient admission to an acute care facility for any reason. Maybe further classified as “related or un-related” to the home infusion therapy.
|
Change in home infusion eligibility
|
Includes, but is not limited to unsafe home environment, no available caregiver, affordability, patient choice, unable to comply with treatment.
|
Insufficient response/ complication
|
Applies when the patient stops treatment due to an exacerbation of disease or nonresponse to therapy.
|
Adverse drug reaction (ADR)
|
An undesirable response, other than a known side-effect, that compromises efficacy, and/or causes toxicity.
|
Access device related
|
When one of the following access device events (migration, dislodgement, occlusion, phlebitis, skin integrity impairment, infection, damage, breakage, or thrombosis) results in the discontinuation of therapy.
|
Change infusion provider
|
Refers to situations where the current provider is unable to meet the patient’s needs.
|
Other
|
All reasons that cannot be otherwise classified.
|
Home infusion provider locations were invited to participate. Those who accepted the invitation were given an Excel® data collection form that included the study variables, provider’s data participation code, patient age, and therapy type. The data collection forms were submitted to NHIF quarterly.
The data was analyzed using IBM SPSS, a statistical analysis software platform. To better describe patient age, it was recoded into 5 categories: 0-16, 17-29, 30-49, 50-64, and 65+. This also allowed the data to be cross tabulated with ADRs and unplanned hospitalizations. Frequency and percentages were determined for the age groups and therapy types.
Age Category |
Frequency |
Percent |
---|---|---|
0-16
|
233
|
4.32
|
17-29
|
274
|
5.08
|
30-49
|
879
|
16.30
|
50-64
|
1,629
|
30.21
|
65+
|
2,378
|
44.09
|
Total
|
5,393
|
100.00
|
Therapy Type |
Frequency |
Percent |
---|---|---|
Anti-infectives
|
3,766
|
69.99
|
Enteral nutrition
|
413
|
7.68
|
Biologics
|
288
|
5.35
|
Hydration
|
227
|
4.22
|
Parenteral nutrition
|
190
|
3.53
|
Other
|
144
|
2.68
|
Pain management
|
132
|
2.45
|
Anti-neoplastic chemotherapy
|
116
|
2.16
|
Inotropic
|
66
|
1.23
|
Immune globulin IV & SC
|
39
|
.72
|
Total
|
5,381
|
100.00
|
Status at Dischage |
Frequency |
Percent |
---|---|---|
Therapy completed
|
4,363
|
80.87
|
Patient expired
|
257
|
4.76
|
Unplanned hospitalization
|
198
|
3.67
|
Other
|
184
|
3.41
|
Change infusion provider
|
176
|
3.26
|
Change in eligibility
|
139
|
2.58
|
Insufficient response/ complication
|
29
|
.54
|
Access device related
|
29
|
.54
|
Adverse drug reaction (ADR)
|
20
|
.37
|
Total
|
5,395
|
100.00
|
ADR Severity |
Frequency |
Percent of ADRs |
---|---|---|
Mild
|
6
|
30.00
|
Moderate
|
4
|
20.00
|
Severe
|
5
|
25.00
|
Serious
|
4
|
20.00
|
Severity not reported
|
1
|
5.00
|
Total
|
20
|
100.00
|
Therapy Type |
Unplanned hospitalization |
ADR |
---|---|---|
Anti-infectives (n=3,766)
|
3.85
|
0.45
|
Parenteral nutrition (n=190)
|
8.42
|
0
|
Enteral nutrition (n=413)
|
0.97
|
0
|
Hydration (n=227)
|
3.96
|
0
|
Pain management (n=132)
|
1.52
|
0
|
Inotropic (n=66)
|
15.15
|
0
|
Anti-neoplastic chemotherapy (n=116)
|
4.31
|
0
|
Immune globulin IV & SC (n=39)
|
5.13
|
0
|
Biologics (n=288)
|
0.35
|
0.69
|
Other (n=144)
|
2.78
|
0.69
|
Total (5,381)
|
3.68
|
0.37
|
0-16 (n=233) |
17-29 (n=274) |
30-49 (n=879) |
50-64 (n=1,629) |
65+ (n=2,378) |
Total (n=5,393) |
|
---|---|---|---|---|---|---|
Unplanned hospitalization
|
4.29
|
4.01
|
3.19
|
3.19
|
4.04
|
3.65
|
Adverse Drug Reaction
|
0
|
0.73
|
0.46
|
0.43
|
0.29
|
0.37
|
The findings of this pilot study reveal a very low rate of ADRs (0.37%) and unplanned hospitalizations (3.68%) as a reason for discharge from a home infusion service. These rates should make physicians and patients more confident in using the home setting for infusion therapy.
This study included “Status at Discharge” data from 17 home infusion provider locations and contributes evidence on the safety of home infusion. Additionally, patient age and therapy type data assisted in describing the home infusion patient. Almost 70% of the patients received anti-infectives followed by enteral nutrition and biologics. ADRs and unplanned hospitalizations as a reason for discharge had low rates, 0.37% and 3.68% respectively. These rates are consistent with previous studies that indicate home is a clinically safe alternative site of care for patients requiring infused medications. Also noteworthy is the percentage (80.87%) of patients who completed their therapy as a reason for discharge and the few (0.54%) access device-related reasons for patient discharge.
The main strength of this pilot study was that it measured the ADR and unplanned hospitalization rate for the home infusion industry, thus providing evidence on the safety of home infusion. Moreover, this study provides support for a larger study of its type. More provider locations will be recruited for a future study and data will be collected over a longer timeframe. This will ensure that the data is more generalizable across the industry and more valid for the therapy types with a small sample size due to longer length of stay within the home infusion service. With additional provider location participation, a more detailed analysis can be conducted, shared, and applied to the industry.
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