Use of remote patient monitoring in the care of COVID-positive patients in oncology.

1554 Background: Cancer patients face an increased risk of developing acute complications from COVID-19. Remote monitoring can help with the critical need for early detection of symptoms among those diagnosed with COVID-19, enabling timely symptom management that can mitigate clinical deterioration. In response to this need, Memorial Sloan Kettering Cancer Center fast-tracked a program to monitor patients with COVID-19 from home, using an electronic symptom-tracking questionnaire and digital pulse oximeter to track patients’ status and alert care teams to intervene if symptoms worsened. A multi-disciplinary group composed of Oncology providers, advanced practice providers, nursing, nursing informatics and biomedical informatics formed to manage the program. Methods: Memorial Sloan Kettering launched a remote monitoring program for patients diagnosed with COVID-19 on March 25, 2020. All patients testing positive for COVID-19 were enrolled in the program and asked to complete a daily symptom tracking questionnaire accessed through their patient portal or administered verbally over the phone. A subset of high risk patients were also provided with a digital pulse oximeter linked to their patient portal and capable of transmitting readings directly to the care team. Clinicians received alerts for patients reporting symptoms or an oxygen saturation below 92%. Alerts resulted in an immediate response from the care team to determine if the patient needed additional care. We retrospectively evaluated the program usage, outcomes and learnings from March 25, 2020 to December 22, 2020. Results: In total, 1,721 patients were enrolled in the program from March 25, 2020 to December 22, 2020. Among these, 210 were deemed high risk patients who received a pulse oximeter in addition the daily symptom questionnaire. Over this period, 27% of patients triggered an alert from an electronic symptom questionnaire, and 63% of patients with a pulse oximeter triggered an alert from their device. Among patients who triggered an alert of any kind, 3% were triaged to a higher level of care. Patients reported that the program was highly valued and alleviated anxiety about their care. Iterative improvements were made to the program over time in response to the evolving knowledge about care for patients with COVID-19. Conclusions: Memorial Sloan Kettering was able to quickly implement a program to detect and triage symptoms among patients with COVID-19 and cancer. Refinements were made over time to many aspects of the program in response to learnings about care related to COVID-19, including to clinical eligibility, alert criteria, monitoring duration and workflows. The program also demonstrated value for patients who felt more comfortable with their care while being monitored remotely. This program established a successful model for remote monitoring of patients with COVID-19 with the potential to be scaled to other institutions or clinical areas.

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Bulletin: New findings show Vascepa significantly reduces cardiovascular events in high-risk patients; Pediatric telemedicine visits yield more antibiotic prescriptions; National data trends show long-term opioid prescriptions increased over time; FDA takes major step to lower insulin prices

Pharmacy Today ◽

10.1016/j.ptdy.2019.04.001 ◽

2019 ◽

Vol 25 (5) ◽

pp. 2-3

Keyword(s):

High Risk ◽

Cardiovascular Events ◽

National Data ◽

Major Step ◽

High Risk Patients ◽

New Findings ◽

Risk Patients ◽

Over Time

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Time-related changes in yield and harms of screening breast MRI.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1508 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1508-1508

Author(s):

Holly Jane Pederson ◽

Colin O'Rourke ◽

Lauren D Bolden ◽

Sobia Khan ◽

Manisha Yadav ◽

...

Keyword(s):

High Risk ◽

False Positive ◽

Short Interval ◽

Breast Mri ◽

Patient Characteristics ◽

Screening Mammography ◽

Significance Level ◽

High Risk Patients ◽

Risk Patients ◽

Over Time

1508 Background: MRI has been accepted as a useful adjunct to screening mammography in high-risk women. Concerns remain over false positive findings, however, and little is known about harms and yield over time. Such information will help women decide about enhanced surveillance. Methods: Of 350 high risk patients offered MRI screening, 320 underwent 757 screens with a 1.5 Tesla magnet from 2008 to 2012 alternating (q 6 mo.) with digital mammography. Data collected included patient characteristics, mammographic density, estimated lifetime risk, and need for additional imaging and/or biopsy. Harms were defined as second look ultrasounds, US or MRI guided core biopsies, surgical biopsies or recommendation for short interval follow up. Estimates of harms over time were modeled by logistic regression. A significance level of 0.05 was used for all testing. Results: Compliance with MRI screening as recommended was 91% with the first MRI, and was not associated with age, race or level of risk. Harms were highest with the first MRI and decreased significantly with subsequent MRIs. Of 59 biopsies, 7 were malignant. Two were found in MRI 1, 3 in MRI 3 and 2 in MRI 4. Women with biopsies resulting from false positive findings were significantly younger (median age 44.5 as compared with 48; p=0.049) and were more likely to have extremely dense breast tissue (36% vs 17%; p=0.028.) Conclusions: This study of highly compliant high risk patients supports the use of MRI as an adjunct to mammography for early detection. The rate of harmful events decreased over time, yet cancer detection did not. This information is critical in counseling women who are considering annual screening breast MRI, particularly younger women and those with dense tissue. [Table: see text]

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Pilot program of remote monitoring for high-risk patients on antineoplastic treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2027 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2027-2027

Author(s):

Robert Michael Daly ◽

Gilad Kuperman ◽

Alice Zervoudakis ◽

Alice Ro ◽

Ankita Roy ◽

...

Keyword(s):

High Risk ◽

Acute Care ◽

Nurse Practitioners ◽

Perceived Value ◽

Patient Portal ◽

Pilot Program ◽

High Risk Patients ◽

Risk Patients ◽

Antineoplastic Treatment

2027 Background: Early detection and management of symptoms in patients with cancer improves outcomes, however, the optimal approach to symptom monitoring and management is unknown. This pilot program uses a mobile health intervention to capture and make accessible symptom data for high-risk patients to mitigate symptom escalation. Methods: Patients initiating antineoplastic treatment at a Memorial Sloan Kettering regional location were eligible. A dedicated staff of RNs and nurse practitioners managed the patients remotely. The technology supporting the program included: 1) a predictive model that identified patients at high risk for a potentially preventable acute care visit; 2) a patient portal enabling daily ecological momentary assessments (EMA); 3) alerts for concerning symptoms; 4) an application that allowed staff to review and trend symptom data; and 5) a secure messaging platform to support communications and televisits between staff and patients. Feasibility and acceptability were evaluated through enrollment (goal ≥25% of new treatment starts) and response rates (completion of > 50% of daily symptom assessments); symptom alerts; perceived value based on qualitative interviews with patients and providers; and acute care usage. Results: Between October 15, 2018 and July 10, 2019, the pilot enrolled 100 high-risk patients with solid tumors and lymphoma initiating antineoplastic treatment (median age: 66 years, 45% female). This represented 29% of patients starting antineoplastics. Over six months of follow-up, the response rate to the daily assessments was 56% and 93% of patients generated a severe symptom alert (Table). Both patients and providers perceived value in the program and 5,010 symptom-related secure messages were shared between staff and enrolled patients during the follow-up period. There was a preliminary signal in acute care usage with a 17% decrease in ED visits compared to a cohort of high-risk unenrolled patients. Conclusions: This pilot program of intensive monitoring of high-risk patients is feasible and holds significant potential to improve patient care and decrease hospital resources. Future work should focus on the optimal cadence of EMAs, the workforce to support remote symptom management, and how best to return symptom data to patients and clinical teams. [Table: see text]

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Trends in conditional survival and predictors of late death in neuroblastoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.10533 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 10533-10533

Author(s):

Hannah Olsen ◽

Kevin M. Campbell ◽

Rochelle Bagatell ◽

Steven G. DuBois

Keyword(s):

Overall Survival ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Primary Site ◽

Conditional Survival ◽

Late Death ◽

High Risk Patients ◽

Risk Patients ◽

Over Time

10533 Background: Significant advances in the treatment of neuroblastoma have been made in the past several decades. There are scant data examining how these improvements have changed over time and differentially affected conditional survival among high- and non-high-risk patient groups. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results Database. We analyzed clinical characteristics and survival outcomes for 4717 neuroblastoma patients. Kaplan-Meier methods were used to estimate overall survival (OS) and conditional overall survival (COS) conditioned on having survived 1, 2, or 5 years from diagnosis, with estimates compared between groups using log-rank tests. Results: Five-year OS was 41.46% (95% CI 38.77-44.13) for the high-risk group and 91.13% (95% CI 89.49-92.53) for the non-high-risk group. Both groups saw significant improvements in OS by decade (p<0.001). Five-year COS among 1-year survivors was 52.69% (95% CI 38.77-44.13) for the high-risk group and 96.75% (95% CI 95.57-97.62) for the non-high-risk group. One-year survivors in the high-risk group showed a statistically significant improvement in COS over time. No difference in COS was observed among 5-year high-risk survivors. There were no statistically significant changes in COS over time for 1- and 5-year survivors in the non-high-risk group. In the high-risk and non-high-risk groups, 82% and 32% of late deaths (>5 years from diagnosis) were attributable to cancer, respectively. Statistically significant adverse prognostic factors for late death were age >1 year at diagnosis, metastatic disease, and non-thoracic primary site (p=0.001). Conclusions: Improvements in COS over time have largely benefited high-risk patients, though they are still at higher risk for late death due to cancer when compared to non-high-risk patients. Age, stage, and primary site, but not treatment decade, influence outcomes among 5-year survivors. [Table: see text]

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The Effects of Care Team Roles on Situation Awareness in the Pediatric Intensive Care Unit: A Prospective Cross-Sectional Study

Journal of Hospital Medicine ◽

10.12788/jhm.3449 ◽

2020 ◽

Vol 15 (10) ◽

pp. 594-597

Author(s):

Blaise T Soberano ◽

Patrick Brady ◽

Toni Yunger ◽

Rhonda Jones ◽

Erin Stoneman ◽

...

Keyword(s):

Intensive Care Unit ◽

High Risk ◽

Situation Awareness ◽

Pediatric Intensive Care ◽

Care Team ◽

Cross Sectional ◽

Risk Status ◽

High Risk Patients ◽

Respiratory Therapists ◽

Risk Patients

Improved situation awareness (SA) decreases rates of clinical deterioration in the pediatric inpatient setting. We used a prospective, cross-sectional, observational study to measure interprofessional care team SA for a pediatric intensive care unit (PICU) patients. The resident, bedside nurse, and respiratory therapist for each patient were surveyed regarding high clinical deterioration risk status as defined by clinical criteria identified by the PICU fellow or attending and mitigation plan. From March 2018 to July 2019, we surveyed 400 care team trios caring for 73 high-risk patients. Nurses identified the patient’s risk status correctly for 375 of 400 patients (94%), respiratory therapists, 380 (95%; P = .4), and residents, 349 (87%; P = .002). For the 73 high-risk patients, nurses were correct 82% of the time, respiratory therapists, 85%, P = .7, and residents, 67%, P = .04. Interventions targeting resident SA are needed within the PICU, especially for high-risk patients.

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InSight Care Pilot Program: Redefining Seeing a Patient

JCO Oncology Practice ◽

10.1200/op.20.00214 ◽

2020 ◽

pp. OP.20.00214

Author(s):

Bobby Daly ◽

Gilad Kuperman ◽

Alice Zervoudakis ◽

Abigail Baldwin Medsker ◽

Ankita Roy ◽

...

Keyword(s):

High Risk ◽

Acute Care ◽

Perceived Value ◽

Improve Patient Care ◽

Symptom Assessment ◽

Program Improvement ◽

Patient Portal ◽

Pilot Program ◽

High Risk Patients ◽

Risk Patients

PURPOSE: Early detection and management of symptoms in patients with cancer improves outcomes. However, the optimal approach to symptom monitoring and management is unknown. InSight Care is a mobile health intervention that captures symptom data and facilitates patient-provider communication to mitigate symptom escalation. PATIENTS AND METHODS: Patients initiating antineoplastic treatment at a Memorial Sloan Kettering regional location were eligible. Technology supporting the program included the following: a predictive model that identified patient risk for a potentially preventable acute care visit; a secure patient portal enabling communication, televisits, and daily delivery of patient symptom assessments; alerts for concerning symptoms; and a symptom-trending application. The main outcomes of the pilot were feasibility and acceptability evaluated through enrollment and response rates and symptom alerts, and perceived value evaluated on the basis of qualitative patient and provider interviews. RESULTS: The pilot program enrolled 100 high-risk patients with solid tumors and lymphoma (29% of new treatment starts v goal of 25%). Over 6 months of follow-up, the daily symptom assessment response rate was 56% (the goal was 50%), and 93% of patients generated a severe symptom alert. Patients and providers perceived value in the program, and archetypes were developed for program improvement. Enrolled patients were less likely to use acute care than were other high-risk patients. CONCLUSION: InSight Care was feasible and holds the potential to improve patient care and decrease facility-based care. Future work should focus on optimizing the cadence of patient assessments, the workforce supporting remote symptom management, and the return of symptom data to patients and clinical teams.

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