Successful implementation of an ePRO remote monitoring system in patients receiving chemotherapy in a community oncology practice.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1526-1526
Author(s):  
Michael A. Kolodziej ◽  
Lavi Kwiatkowsky ◽  
Jeff Hunnicutt ◽  
Joseph Thaddeus Beck ◽  
Eric S. Schaefer ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Remote Monitoring ◽  
Office Visit ◽  
Distress Thermometer ◽  
Successful Implementation ◽  
Oncology Group ◽  
Symptom Monitoring ◽  
Remote Monitoring System ◽  
Patient Reported ◽  
Tumor Types

1526 Background: Remote symptom monitoring of patients receiving cancer treatment has been shown to improve patient outcomes in the research setting. However, there is little evidence that this technology can be implemented and scaled in the real world with the same benefits. Methods: Highlands Oncology Group (HOG) is a 19 physician medical oncology group in Northwest Arkansas. Beginning in June 2020, HOG offered patients receiving parenteral cancer therapy enrollment onto Expain: an EMR-integrated, electronic patient-reported outcomes (ePRO) system which enables remote symptom monitoring during systemic cancer therapy. Patients reported distress and symptoms using the NCCN Distress Thermometer and Problem List instrument. The practice prospectively defined patient reporting intervals based on disease and treatment protocol, as well as thresholds for each symptom that would trigger a nursing notification. Following clinical review, nurses initiated interventions including a telephone call, urgent office visit, or referral to an emergency room when necessary. Results: From June 2020 – January 2021, HOG treated 1261 patients with IV chemotherapy. 769 patients were offered enrollment and 569 (73.9%) were successfully enrolled onto the ePRO system. At the time of enrollment 419 (73.6%) of enrolled patients were in an Oncology Care Model (OCM) episode. Common reasons for declined enrollment were: low symptom burden, non-English speaker, and approaching the end of treatment. Of enrolled patients, the most common tumor types were: gastrointestinal (21.8%), breast (17.5%), and thoracic (16.1%). Patients reported using Expain’s mobile app (89.1%) or Interactive Voice Response interface (IVR, 10.1%) with the following frequency: once a month (12%), twice a month (30%), 3 reports a month (35%), and 4 reports or more (23%); Of patients successfully enrolled 52.72% were still reporting after 3 months. The most common reasons specified for opting-out were: death, hospice admission, and completion of the treatment course. 50% of reports exceeded the practice-defined threshold for a nursing notification. The nurses initiated a follow-up call in response to 78.8% of notifications, and of these calls, 21.2% resulted in an urgent office evaluation. The most common problems triggering an office evaluation were: high NCCN Distress Thermometer score (17.1%), fatigue (16.1%), pain (11.5%), nausea (9.4%), and dyspnea (4.5%). Conclusions: ePRO-based remote monitoring of patients receiving parenteral cancer therapy in routine clinical care is feasible. Patient enrollment and retention are high across all tumor types. Symptoms reported by patients were concordant with previous publications, and a small percent (7% of reports) required an acute office visit. It is expected that office intervention will reduce the use of ER and inpatient services.

Which electronic patient’s reported outcome should I choose for remote monitoring of my cancer patients? (Preprint)

2021 ◽  
Author(s):  
Fabrice Denis
Keyword(s):  
Cancer Patients ◽  
Remote Monitoring ◽  
Survival Benefit ◽  
Patient Reported Outcome ◽  
Controlled Trials ◽  
Symptom Monitoring ◽  
Best Value ◽  
Patient Reported ◽  
Oncology Practice

UNSTRUCTURED Abstract Digital electronic patient reported outcome (ePRO) systems for symptom monitoring in cancer patients demonstrated evidence of quality of life and survival benefit in controlled trials. They are beginning to be used in routine oncology practice. Many software editors provide solutions to clinicians but how can clinician choose it? We propose a synthesis of the main questions about effectiveness, safety and functionality of ePRO system that may ask clinician to software providers to be helped in selecting a software in order to obtain the best value of these tools for their patients and their practice.

Capturing and addressing emotional well-being: Utilization of ASCO’s Quality Oncology Practice Initiative (QOPI) for performance improvement.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 207-207
Author(s):  
Patricia D. Hegedus ◽  
James D. Bearden ◽  
Bruce Grant
Keyword(s):  
Performance Improvement ◽  
Office Visit ◽  
Well Being ◽  
Psychological Services ◽  
Distress Thermometer ◽  
Improvement Project ◽  
Face To Face ◽  
Intervention Process ◽  
Patient Reported ◽  
Oncology Practice

207 Background: Palmetto Hematology Oncology (PHO) is the medical oncology practice of Spartanburg Regional Healthcare System (SRHS) and has participated in QOPI since 2009 and earned QOPI certification in September 2011. Emotional well-being assessments and documentation of interventions were selected for a performance improvement project based on QOPI measures from Fall 2009. Methods: Several articles were identified supporting the use of the NCCN Distress Thermometer following a comprehensive literature search and approval was obtained for use. The NCCN Distress Thermometer was administered to all new patients through inclusion in “new patient” paperwork packets. Two physician offices within the practice were piloted with the physicians reviewing the patient reported assessments and documenting any required interventions. All completed NCCN Distress Thermometer forms were also reviewed by the medical social work team, and for scores > 3, interventions by phone or face-to-face were completed by them and documented in the patients’ electronic medical records. Results: Due to the success of the pilot efforts the assessment/intervention process for emotional well-being was expanded throughout the PHO practice, the Gibbs Infusion Center, and Radiation Oncology. The QOPI emotional well-being indicator revealed an increase from the Fall 2009 to Spring 2012 of 36.25% to 96.25%. Conversely, our compliance with intervention by the second office visit decreased from 94.44% to 69.44%, respectively. Conclusions: Although PHO’s scores for the emotional well-being assessment have dramatically improved with implementation of the process improvement initiative, opportunity remains for improving emotional well-being intervention documentation. This initiative highlighted the lack of psychiatric/psychological services available to PHO patients. References: NCCN Clinical Practice Guidelines in Oncology: Distress Management, Version 3.2012; Available at: http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf . QOPI The Quality Oncology Practice Initiative; Available at: http://qopi.asco.org/program .

scholarly journals Remote monitoring of COVID-19 positive high-risk patients in domestic isolation: A feasibility study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257095
Author(s):  
David Wurzer ◽  
Paul Spielhagen ◽  
Adonia Siegmann ◽  
Ayca Gercekcioglu ◽  
Judith Gorgass ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Mobile Network ◽  
Early Warning Score ◽  
Individual Risk ◽  
Successful Implementation ◽  
Invasive Ventilation ◽  
Remote Monitoring System ◽  
Daily Monitoring ◽  
Hospitalised Patients ◽  
Risk Patients

Background If a COVID-19 patient develops a so-called severe course, he or she must be taken to hospital as soon as possible. This proves difficult in domestic isolation, as patients are not continuously monitored. The aim of our study was to establish a telemonitoring system in this setting. Methods Oxygen saturation, respiratory rate, heart rate and temperature were measured every 15 minutes using an in-ear device. The data was transmitted to the Telecovid Centre via mobile network or internet and monitored 24/7 by a trained team. The data were supplemented by daily telephone calls. The patients´ individual risk was assessed using a modified National Early Warning Score. In case of a deterioration, a physician initiated the appropriate measures. Covid-19 Patients were included if they were older than 60 years or fulfilled at least one of the following conditions: pre-existing disease (cardiovascular, pulmonary, immunologic), obesity (BMI >35), diabetes mellitus, hypertension, active malignancy, or pregnancy. Findings 153 patients (median age 59 years, 77 female) were included. Patients were monitored for 9 days (median, IQR 6–13 days) with a daily monitoring time of 13.3 hours (median, IQR 9.4–17.0 hours). 20 patients were referred to the clinic by the Telecovid team. 3 of these required intensive care without invasive ventilation, 4 with invasive ventilation, 1 of the latter died. All patients agreed that the device was easy to use. About 90% of hospitalised patients indicated that they would have delayed hospitalisation further if they had not been part of the study. Interpretation Our study demonstrates the successful implementation of a remote monitoring system in a pandemic situation. All clinically necessary information was obtained and adequate measures were derived from it without delay.

scholarly journals Mobile-Health Tool to Improve Care of Patients with Hematological Malignancies

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 35-36
Author(s):  
Amit Sanyal ◽  
James M. Heun ◽  
Jessica Sweeney ◽  
Clemens Janssen
Keyword(s):  
Quality Of Life ◽  
Patient Experience ◽  
Cancer Care ◽  
Hematological Malignancies ◽  
Distress Thermometer ◽  
Myelogenous Leukemia ◽  
Shortness Of Breath ◽  
Symptom Monitoring ◽  
Patient Reported

INTRODUCTION Adverse effects are common during treatment of hematological malignancies. Treatment toxicities can impact quality of life [1], impose financial hardship and cause cancer related distress[2]. Symptom monitoring using electronic technology can facilitate early detection of complications[3], reduce symptom burden[4], cost of care[5] and improve survival[6]. Cancer treatment also increases risk of mortality from infections such as coronavirus disease 2019 (COVID-19) and routine screening has been recommended[7]. METHODS We developed an application that periodically delivers toxicity questionnaires to patients during treatment . Based on NCI- PRO-CTCAE™, the questions are delivered through SMS or e-mail. Patient responses crossing prespecified thresholds trigger automated alerts on a dashboard, resulting in additional interventions as needed. Nature and time to intervention is tracked. Patient experience is measured using a Likert-scale and free-text box. Centers for Disease Control recommended COVID-19 screening questions were incorporated. Finally, a distress thermometer for cancer distress screening has been recently added. The app was offered to patients with hematological cancers in a community-based cancer center. RESULTS Since introduction in April 2020, we have enrolled 37 patients. 9 patients had chronic lymphocytic leukemia, 6 diffuse large B cell, 5 mantle cell, 4 Hodgkin's and 3 follicular lymphoma. 2 each had chronic myelogenous, multiple myeloma and Richter's syndrome. 1 each had hairy cell leukemia, acute myelogenous leukemia and T Cell lymphoma. Median age was 64 years (range 24-85). Patient experience has been favorable. On a scale of 1-5, 85.5% rated the experience as 3 or higher. Median patient engagement, calculated by dividing the number of forms completions by number of days enrolled was 34.2% (0.9-66.2 %). Symptom tracker captured 536 responses. Fatigue (153), no symptoms (152), shortness of breath (57), nausea/vomiting, diarrhea (46) and numbness/tingling (28) were the most common response categories. Of 1107 completed check ins, 75 triggered flags. There were 2 hospitalizations for neutropenic fever with the remainder managed as outpatients. Average time between patient generated response and provider intervention was 90.9 minutes. 88% follow-ups were completed within 1 business day. COVID-19 screening module captured 1096 responses. 988 were no symptoms. All positive responses (44 diarrhea, 39 cough, 23 shortness of breath and 2 fever) were false positives. Distress thermometer implemented a week before data cut-off captured 2 responses, 1 in the physical and 1 in the psychological domain. CONCLUSION We demonstrate feasibility of electronic capture of treatment toxicities and offer proof of concept that a mobile app can be used for infection screening. Additionally, the quick response time by care team indicated a high adoption rate. REFERENCES Doorduijn J, B.I., Holt B, Steijaert M, Uyl-de Groot C, Sonneveld P., Self-reported quality of life in elderly patients with aggressive non-Hodgkin's lymphoma treated with CHOP chemotherapy. . European Journal of Hemtology 2005. 75(2): p. 116-123.Troy JD, L.S., Samsa GP, Feliciano J, Richhariya A, LeBlanc TW., Patient-reported distress in Hodgkin lymphoma across the survivorship continuum. Supportive Care Cancer, 2019. 27(7): p. 2453-2462.Stover A M, H.S., Deal A M, Stricker C T, Bennett A V, Carr P M, Jansen J, Kottschade L A, Dueck A C, Basch E M, Methods for alerting clinicians to concerning symptom questionnaire responses during cancer care: Approaches from two randomized trials (STAR, AFT-39 PRO-TECT). Journal of Clinical Oncology 2018. 36(30 supplement): p. 158.Mooney KH, B.S., Wong B, Whisenant M, Donaldson G, Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT. Cancer Medicine, 2017. 6(3): p. 537-546.Barkley R, S.M.-J., Wang J, Blau S, Page RD, Reducing Cancer Costs Through Symptom Management and Triage Pathways. Journal of Oncology Practice, 2019. 15(2): p. e91-e97.Denis F, B.E., Septans AL, Urban T, Dueck AC, Letellier C., Two-Year Survival Comparing Web-Based Symptom Monitoring vs Routine Surveillance Following Treatment for Lung Cancer. JAMA, 2019. 321(3): p. 306-307.ASCO Special Report: A guide to cancer care delivery during COVID-19 pandemic. 2020, ASCO: Alexandria, VA. Disclosures Janssen: wellbe Inc.: Current Employment.

An IT-integrated, computer-based telephone system for monitoring patient-reported symptoms: Result of two trials.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 2-2 ◽  
Author(s):  
Kathi Mooney ◽  
Susan L. Beck ◽  
Bob Wong ◽  
William A. Dunson ◽  
Debra Wujcik
Keyword(s):  
Remote Monitoring ◽  
Symptom Severity ◽  
Severe Symptom ◽  
Poor Sleep ◽  
Remote Monitoring System ◽  
Oncology Nurse ◽  
Outpatient Chemotherapy ◽  
Patient Reported ◽  
Oncology Providers ◽  
Evidence Based Guidelines

2 Background: An automated remote monitoring system of patient reported symptoms was tested in two separate trials to determine if it improved unrelieved symptoms after outpatient chemotherapy. Methods: In Study 1,250 patients and Study 2,335 patients beginning a chemotherapy course were randomized to Telephone Care (TC) (n 129/174) or usual care (UC) (n 121/162). All called daily reporting presence, severity, and distress (0-10 scale) for 11 common symptoms. Those in the Study 1 TC group had reports of moderate to severe symptoms emailed to their oncologist and oncology nurse. Those in Study 2 TC group had similar moderate to severe symptom reports sent to a study Nurse Practitioner (NP) who responded by telephone utilizing evidence based guidelines to intensify symptom care. These patients also received automated tailored self-care messages based on their specific symptoms. Results: The majority of participants in both studies were white (91%; 84%) and female (76%; 77%). The mean age was 56 years, with breast cancer most common (40%; 45%). Mean study days were 45 (Study 1) and 73 (Study 2) with 66% and 87% call completion days respectively. Fatigue, pain, poor sleep, nausea and depressed mood were reported as moderate to severe by over 50% of patients in both studies. In Study 1 no difference was found in symptom severity between TC and UC. Oncology providers found the TC symptom alerts useful but rarely initiated symptom care intensification. In Study 2 the TC group mean symptom score was significantly lower than UC, p < .001. Poisson regression showed TC had fewer Severe symptom days than UC (est. means and SE) 3.16 (0.44) vs. 10.24 (1.84), p < .001; and fewer Moderate days 8.91 (1.04) vs. 19.06 (2.22), p < .001. TC had somewhat higher Mild days 19.85 (2.81) vs. 13.75 (1.85), p = .06; and more no symptom days 66.06 (3.82) vs 52.02 (4.15), p = .01. Conclusions: Remote monitoring of patient reported symptoms after chemotherapy is effective in identifying unrelieved symptoms. It can be used to track quality improvement as well as augment symptom care. Follow up to intensify symptom treatment utilizing guidelines is necessary to achieve significant reductions in symptom severity, distress and days of moderate or severe symptoms.

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