PCN21 CANCER CHEMOTHERAPY AT HOME: FEASIBILITY, PATIENT OUTCOMES, AND HEALTHCARE SYSTEM IMPLICATIONS

IntroductionEmergency department (ED) overcrowding is a major healthcare problem associated with worse patient outcomes and increased costs. Attempts to reduce ED overcrowding of patients with cardiac complaints have so far focused on in-hospital triage and rapid risk stratification of patients with chest pain at the ED. The Hollands-Midden Acute Regional Triage—Cardiology (HART-c) study aimed to assess the amount of patients left at home in usual ambulance care as compared with the new prehospital triage method. This method combines paramedic assessment and expert cardiologist consultation using live monitoring, hospital data and real-time admission capacity.Methods and analysisPatients visited by the emergency medical services (EMS) for cardiac complaints are included. EMS consultation consists of medical history, physical examination and vital signs, and ECG measurements. All data are transferred to a newly developed platform for the triage cardiologist. Prehospital data, in-hospital medical records and real-time admission capacity are evaluated. Then a shared decision is made whether admission is necessary and, if so, which hospital is most appropriate. To evaluate safety, all patients left at home and their general practitioners (GPs) are contacted for 30-day adverse events.Ethics and disseminationThe study is approved by the LUMC’s Medical Ethics Committee. Patients are asked for consent for contacting their GPs. The main results of this trial will be disseminated in one paper.DiscussionThe HART-c study evaluates the efficacy and feasibility of a prehospital triage method that combines prehospital patient assessment and direct consultation of a cardiologist who has access to live-monitored data, hospital data and real-time hospital admission capacity. We expect this triage method to substantially reduce unnecessary ED visits.

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Nocturnal Sleep–Wake Parameters of Adolescents at Home Following Cancer Chemotherapy

Biological Research For Nursing ◽

10.1177/1099800411408414 ◽

2011 ◽

Vol 14 (3) ◽

pp. 236-241 ◽

Cited By ~ 3

Author(s):

Amy J. Walker ◽

Kyle P. Johnson ◽

Christine Miaskowski ◽

Vivian Gedaly-Duff

Keyword(s):

Sleep Duration ◽

Cancer Chemotherapy ◽

Sleep Onset ◽

Sleep Diary ◽

Nocturnal Sleep ◽

Wake Time ◽

Targeted Interventions ◽

Time In Bed ◽

Wrist Actigraphy ◽

At Home

Purpose: The purpose of this descriptive, longitudinal study was to describe objective nocturnal sleep–wake parameters of adolescents at home after receiving chemotherapy in the hospital or outpatient clinic and explore differences in sleep variables by age, gender, and corticosteroid use. Methods: We collected 7 days of wrist actigraphy and sleep diary data from 48 adolescents (10–19 years) who were receiving cancer chemotherapy for a primary or secondary cancer or a relapse. The actigraphic sleep variables included rest interval (i.e., time in bed), sleep onset, sleep offset, sleep duration, total sleep time (TST), wake after sleep onset (WASO), and %WASO. Results: Of the 48 adolescents, 38 had at least five nights of scored actigraphy and were included in analyses. Older (13–18 years) adolescents went to bed later and had fewer minutes of TST than younger adolescents (10–12 years). Exploratory analyses revealed no differences between adolescents who were taking oral corticosteroids (i.e., prednisone, dexamethasone) and those who were not or between males and females. Conclusion: These adolescents had sleep durations that met or exceeded the recommended sleep duration for their age groups but experienced significant WASO. Further research is needed to estimate sleep needs of adolescents during chemotherapy and determine factors that contribute to nocturnal wake-time so that targeted interventions can be designed to improve sleep quality.

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Abstract 16125: Impact of COVID-19 on Echocardiography Volume at a Large Academic Medical Center

Circulation ◽

10.1161/circ.142.suppl_3.16125 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Merilyn S Varghese ◽

Jordan B Strom ◽

Sarah Fostello ◽

Warren J Manning

Keyword(s):

Patient Outcomes ◽

Hospital Admissions ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Hospital Systems ◽

The Impact ◽

At Home

Introduction: COVID-19 has significantly impacted hospital systems worldwide. The impact of statewide stay-at-home mandates on echocardiography volumes is unclear. Methods: We queried our institutional echocardiography database from 6/1/2018 to 6/13/2020 to examine rates of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) prior to and following the COVID-19 Massachusetts stay-at-home order on March 15, 2020. Results: Among 36,377 total studies performed during the study period, mean weekly study volume dropped from 332 + 3 TTEs/week, 30 + 1 SEs/week, and 21 + 1 TEEs/week prior to the stay-at-home order (6/1/2018-3/15/2020) to 158 + 13 TTEs/week, 8 + 2 SEs/week, and 8 + 1 TEEs/week after (% change, -52%, -73%, and -62% respectively, all p < 0.001 when comparing volume prior to March 15 versus after). Weekly TTEs correlated strongly with hospital admissions throughout the study period (r = 0.93, 95% CI 0.89-0.95, p < 0.001) ( Figure ). Outpatient TTEs declined more than inpatient TTEs (% change, -74% vs. -39%, p <0.001). As of 3 weeks following the cessation of the stay-at-home order, TTE, SE, and TEE weekly volumes have increased to 73%, 66%, and 81% of pre-pandemic levels, respectively. Conclusions: Echocardiography volumes fell precipitously following the Massachusetts stay-at-home order, strongly paralleling declines in overall hospitalizations. Outpatient TTEs declined more than inpatient TTEs. Despite lifting of the order, echocardiography volumes remain substantially below pre-pandemic levels. The impact of the decreased use of echocardiographic services on patient outcomes remains to be determined.

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Value-Based Health Care Supported by Data Science

Fundamentals of Clinical Data Science ◽

10.1007/978-3-319-99713-1_14 ◽

2018 ◽

pp. 193-212 ◽

Cited By ~ 1

Author(s):

Tiffany I. Leung ◽

G. G. van Merode

Keyword(s):

Health Care ◽

Service Delivery ◽

Health System ◽

Healthcare System ◽

Patient Outcomes ◽

Data Science ◽

Costs Of Care ◽

Learning Health System ◽

Measuring Outcomes ◽

Cost Measurement

AbstractThe value agenda involves measuring outcomes that matter and costs of care to optimize patient outcomes per dollar spent. Outcome and cost measurement in the value-based health care framework, centered around a patient condition or segment of the population, depends on data in every step towards healthcare system redesign. Technological and service delivery innovations are key components of driving transformation towards high-value health care. The learning health system and network-based thinking are complementary frameworks to the value agenda. Health care and medicine exist in a data-rich environment, and learning about how data can be used to measure and improve value of care for patients is and increasingly essential skill for current and future clinicians.

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Patient Outcomes after Placement of PEG at Bay Pines VA Healthcare System

The American Journal of Gastroenterology ◽

10.14309/00000434-200809001-00967 ◽

2008 ◽

Vol 103 ◽

pp. S379-S380

Author(s):

Angelo Fernandes ◽

Tri Huynh ◽

Mitchel Hoffman ◽

Terri Buchanan

Keyword(s):

Healthcare System ◽

Patient Outcomes

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Voluntary Cyclical Distancing: A potential alternative to constant level mandatory social distancing, relying on an ‘infection weather report’

10.1101/2020.05.02.20084947 ◽

2020 ◽

Author(s):

Daniel Goldman

Keyword(s):

Healthcare System ◽

Constant Level ◽

Daily Lives ◽

Social Distancing ◽

Alternative Approach ◽

Potential Alternative ◽

At Home

1AbstractCOVID-19 has significantly changed our daily lives. Stay-at-home orders and forced closings of all non-essential businesses has had a significant impact on our economy. While it is important to ensure that the healthcare system is not overwhelmed, there are many questions that remain about the efficacy of extreme social distancing, and whether there are alternatives to mandatory lockdowns. This paper analyzes the utility of various levels of social distancing, and suggests an alternative approach using voluntary distancing informed by an infectious load index or ‘infection weather report.’

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Home-Based Physiological Monitoring of Patients with COVID-19

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc005-21 ◽

2021 ◽

Vol 23 (3) ◽

pp. 76-88

Author(s):

Akshay Warrier ◽

◽

Akshay Sood

Keyword(s):

Healthcare System ◽

Patient Outcomes ◽

Clinical Implications ◽

Physiological Monitoring ◽

Software Applications ◽

Home Based ◽

The Future ◽

New Devices

The COVID-19 pandemic has necessitated the rise of telehealth modalities to relieve the incredible stress the pandemic has placed on the healthcare system. This rise has seen the emergence of new software, applications, and hardware for home-based physiological monitoring, leading to the promise of innovative predictive and therapeutic practices. This article is a literature-based review of the most promising technologies and advances regarding home-based physiological monitoring of patients with COVID-19. We conclude that the applications currently on the market, while helping stem the flow of patients to the hospital during the pandemic, require additional evidence related to improvement in patient outcomes. However, new devices and technology are a promising and successful venture into home-based monitoring with clinical implications reaching far into the future.

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The Netherlands—zorg in de gemeenschap

Human: Solving the global workforce crisis in healthcare ◽

10.1093/oso/9780198836520.003.0008 ◽

2019 ◽

pp. 61-66

Author(s):

Mark Britnell

Keyword(s):

Primary Care ◽

Older People ◽

Healthcare System ◽

Long Term Care ◽

Term Care ◽

The World ◽

Care At Home ◽

General Care ◽

At Home

The Dutch healthcare system is considered by many to be one of the finest in the world because of its pioneering provision and decent level of funding. ‘Zorg in de gemeenschap’ or ‘care in the community’ is a both a distinguishing and defining feature of the Dutch cure and care system. The Dutch spend around 3.7% of their GDP on long-term care, the highest in the OECD, and offer many examples of innovation in caring for older people in the community and at home. Nearly 13% of the population aged over 65 receive care at home, compared with just 4.9% across the OECD. In this chapter, Mark Britnell looks at the Dutch healthcare system; its structure, funding, future, and much else. He points out that a strength of the Dutch healthcare system is the emphasis placed on well-resourced primary care, and looks at how it affects general care.

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An Information Sharing System for Multi-Professional Collaboration in the community-based integrated healthcare system

International Journal of Informatics, Information System and Computer Engineering (INJIISCOM) ◽

10.34010/injiiscom.v2i1.4862 ◽

2021 ◽

Vol 2 (1) ◽

pp. 1-14

Author(s):

Hideaki Kanai ◽

◽

Akinori Kumazawa ◽

Keyword(s):

Information Sharing ◽

Elderly People ◽

Healthcare System ◽

The Elderly ◽

Professional Collaboration ◽

Community Based ◽

Integrated Healthcare ◽

Comprehensive Health ◽

One Year ◽

At Home

Currently, Japan is rapidly aging. Japanese government agencies report that the percentage of elderly people whose ages are at least 65 years will increase by up to about 30 percent in 2025. As one of the measures towards this situation, the community-based integrated healthcare system will be introduced in Japan. The system aims to provide elderly people living at home with appropriate health, medical, and welfare services. We focus on the burden of sharing information on the situation of the elderly at home among health, medical, welfare staffs, and neighbors. We have been developing a supporting system for sharing information on the situation of the elderly at home and conducted a field test around one year. We consider that various stakeholders involved in the community comprehensive health care system could recognize the importance of information sharing and collaboration with them through this kind of social implementation

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