Purpose/goal: 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 pandemic, and forecasts indicate these site-of-care trends will continue in the future.1, 2 In addition to the hospital outpatient department (HOPD), infusions may also be administered in a stand-alone infusion center, a dedicated infusion area within a specialty medicine clinic or office building, or a patient home when coordinated through a qualified home health agency. Each service delivery platform has benefits and challenges as well as cost considerations. Expanded health care 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 can limit where these 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 • Approximately 80 autoimmune disorders exist. In 2012, Drs. Scott Hayter and Mathew Cook published a study showing there is an estimated prevalence in the US of 14.7 million people with an autoimmune disorder (based on the current US population of 320 million).5 • The 2019 National Home Infusion Association (NHIA) study reported that home infusions increased 300% 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 formulate the treatment location options and associated requirements, benefits, and challenges.
Results: The four outpatient site-of-care options noted previously were categorized with benefits and challenges of each to provide a reference guide for nurses 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 managers 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/aboutinfusion-therapy 3. American Cancer Society. Cancer Facts and Figures. 2021 https://www.cancer.org/content/dam/cancerorg/research/cancer-facts-and- statistics/annual- cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf 4. 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 5. Advisory Board Company. Payer trends impacting health system infusion services. Published on October 27, 2020. Accessed on 01-27-2021 from www.advisory.com/topics/classic/2020/10/payer-trends-impacting-healthsystem-infusion- services