National Scaling of Home Emergency Response Teams for Palliative Care Patients: Lessons From the Proof-of-Concept Model.

Abstract

Patients with advanced illness often experience acute distressing symptoms leading to unplanned hospitalizations, despite a preference to remain at home. Existing home-based care models frequently lack the responsiveness and clinical intensity to manage such emergencies. To assess the operational robustness and clinical impact of the Home Emergency Response Team for Palliative Care Patients (HERT-P) prototype during its regional scale-up in France. This three-year observational study (2021-2024), conducted without a control group, evaluated an innovative model integrating critical and palliative care for patients at home. The HERT-P program combined centralized coordination with decentralized mobile teams, expanding from 2 to 4 French departments (3.5 to 7 million residents). All 2326 intervention requests underwent a shared decision-making process. The primary outcome was patient trajectory; secondary outcomes included scalability, cost-effectiveness, and environmental impact. Patients with advanced illness and acute symptom exacerbations were triaged via a 24/7 hotline. Admitted patients received rapid-response care, including curative and palliative interventions, with follow-up through home visits and telemedicine. Of 2326 requests, 1806 patients (78%) were admitted. Among them, 75% died at home, 18% improved, and 1% required emergency department transfer. The program's active caseload increased from 5 to 15 over three years, while reducing per-stay costs by 12%. Compared to equivalent hospital-based care, each intervention generated a 78% lower carbon footprint. These results led the French Ministry of Health to fund 15 new HERT-P teams for national deployment in 2025. The HERT-P model supported home-based trajectories through responsive care and showed potential for scalability.