Patients today have a number of options to consider when determining the optimal location for receiving outpatient infusion therapy and specialty treatments. Defining the benefits and challenges of each site of care will assist nurses to help patients make informed decisions related to infusion therapy treatments.

Background

Chemotherapy, infusions for autoimmune disorders, and other medication treatments are frequently administered outside of the hospital setting, especially during the COVID-19, and forecasts indicate these sites of care trends will continue in the future.^1,2  Infusions are usually administered in one of the following:

• Hospital outpatient department (HOPD)
• Stand-alone infusion center
• Dedicated infusion area within a specialty medicine clinic or office building
• Patient home when coordinated through a qualified home health agency

Each service delivery platform has benefits and challenges as well as cost considerations.  Expanded healthcare coverage through the Affordable Care Act has supported access to infusion services previously unavailable for many; however, reimbursement and out-of-pocket expenses vary and may limit where services are delivered.³ 

 Significance

• According to the American Cancer Society Facts & Figures (2021), almost 1.9 million new cancer cases are expected to be diagnosed in 2021. These numbers do not account for the unknown impact of COVID-19 and delays in seeking care.⁴
• In 2012, Drs. Scott Hayter and Mathew Cook published a study identifying the existence of 81 autoimmune disorders with an overall estimated prevalence of 4.5%. Based on the current US population of 320 million, approximately 14.7 million people in the US may have one or more  autoimmune disorders.⁵
• The 2019 National Home Infusion Association (NHIA) study reported home infusion and specialty providers cared for more than 3 million patients in the US, representing a 300% increase since the last industry study in 2008.²

Method

A systematic review of medical literature, infusion nursing publications and websites, governmental regulations and insurance coverage, and private insurance policies related to outpatient infusions were utilized to determine treatment location options and associated requirements, benefits, and challenges.

Results

The four outpatient site of care options noted above were categorized with the benefits and challenges of each to provide a reference guide for nurse and patients.  Factors that may limit treatment location choices include type of drug administered, patient health status, and insurance coverage.

Conclusion

Nurses, patient navigators, discharge planners, and infusion therapy mangers play a vital role in patient hospital discharge planning or management of outpatient infusion therapy care.  In order to make informed decisions, it is important that patients understand the options and requirements associated with each treatment site.

Resources

1. 2019 Medical Pharmacy Trend Report, Magellan Rx Management Medical Pharmacy Trend Report™. https://issuu.com/magellanrx/docs/mptr2019?fr=sMmE2MTk0MDI3Nw
2. National Home Infusion Association (NHIA). About Home and Specialty Infusion. https://www.nhia.org/about-infusion-therapy
3. Advisory Board Company. Payer trends impacting health system infusion services. Published on October 27, 2020. www.advisory.com/topics/classic/2020/10/payer-trends-impacting-health-system-infusion-services
4. American Cancer Society. Cancer Facts and Figures. 2021 https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf
5. Autoimmune Registry, Inc. (ARI), 501(c)(3) non-profit umbrella organization that provides a hub for research, statistics, and patient data on all autoimmune diseases. https://www.autoimmuneregistry.org/autoimmune-statistics

The Infusion Therapy Poster will be presented at the AMSN Annual Convention September 30-October 3, 2021.

By Janet Woods | August 2021