House Calls

Stem cell transplant patients are highly immune-compromised, so they are among the most vulnerable to COVID-19. That’s why, in early March 2020, as the COVID-19 epidemic ramped up, the Duke Adult Blood and Marrow Transplant program leadership team made home care the standard of care for all active hematopoietic stem cell transplant patients. The team had experience in this area from a National Institutes of Health- funded study of this approach.

The study asked whether at-home care resulted in the patients' gut microbiome remaining intact, leading to better outcomes. "Also, we were asking whether the patients would eat better, exercise more, and feel better. Lastly, we wanted to know if the costs were lower," says Nelson Chao, MD, MBA, director of the Hematologic Malig­nancies & Cellular Therapy disease group.

The benefit of being seen at home during recovery, especially in the COVID-19 era, is that the transplant patient is exposed only to the one provider making the house call, instead of dozens of human and environmental exposures typically encountered at the hospital.

Previously, the only way for such a patient to receive post-transplant care at home (either their permanent home or temporary lodging nearby) was to participate in a clin­ical trial. With these studies, only one or two patients were randomized to receive home care at any one time. Now the home transplant team has made house calls to 26 separate stem cell transplant patients in recovery.

This significant re-deployment was made possible by extensive efforts from the advanced practice providers and nurses currently conducting the home visits, including Chao; Krista Nichols, RN, MSN, AOCNS; and Anthony Sung, MD.