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

CONTEXT: 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. OBJECTIVES: 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. DESIGN: 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. SETTING/PARTICIPANTS: 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. RESULTS: 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. CONCLUSIONS: The HERT-P model supported home-based trajectories through responsive care and showed potential for scalability.