University of Michigan Rogel Cancer Center, Ann Arbor, MI.
University of Michigan College of Pharmacy, Ann Arbor, MI.
JCO Oncol Pract. 2021 Sep;17(9):e1303-e1310. doi: 10.1200/OP.20.00639. Epub 2021 Feb 3.
Chemotherapy-induced nausea and vomiting (CINV) is a common cause of unplanned healthcare utilization. The University of Michigan Rogel Cancer Center initiated the chemotherapy remote care monitoring program (CRCMP) to proactively identify patients experiencing CINV and intervene before the need for urgent evaluation.
High-risk patients for CINV are identified by neurokinin-1 (NK-1) antagonist administration, enrolled in the CRCMP, and received a daily text message survey for 7 days after chemotherapy administration to report symptoms. Responses above a set threshold trigger a message to the team pharmacist for intervention. The primary outcome of 14-day unplanned healthcare use was evaluated before and after CRCMP implementation.
In 8 months, 652 patients received an NK-1 antagonist (2,244 cycles) and 387 patients were enrolled in the CRCMP (59%). Text message response rate was 94%. Clinical pharmacists provided 248 interventions in 121 patient episodes meeting threshold criteria. Fourteen-day unplanned healthcare use was decreased in the CRCMP-enrolled NK-1 episodes (6.68% 4.53%, = .02). Admissions were numerically lower for those enrolling in CRCMP when only admissions for nausea were considered (0.63% 0.35%, = .33).
The CRCMP allowed for real-time management of patient-reported CINV symptom burden based on patient-reported outcomes (PROs) and an electronic medical record-integrated SMS text questionnaire. Clinical pharmacists were key team members to manage patient symptoms. Enrollment in CRCMP significantly reduced overall unplanned healthcare utilization. Although these changes were numerically small, any reduction in unnecessary care utilizing PROs can contribute to high-value care for patients with cancer.
化疗引起的恶心和呕吐（CINV）是计划外医疗保健利用的常见原因。密歇根大学罗格尔癌症中心启动了化疗远程护理监测计划（CRCMP），以主动识别出现 CINV 的患者，并在需要紧急评估之前进行干预。
通过使用神经激肽-1（NK-1）拮抗剂给药来识别 CINV 的高危患者，将其纳入 CRCMP，并在化疗给药后 7 天内每天通过短信调查报告症状。超过设定阈值的反应会触发给团队药剂师的消息进行干预。在实施 CRCMP 之前和之后，评估了 14 天内计划外医疗保健使用的主要结果。
在 8 个月内，652 名患者接受了 NK-1 拮抗剂（2244 个周期）治疗，其中 387 名患者被纳入 CRCMP（59%）。短信回复率为 94%。临床药师在满足阈值标准的 121 个患者事件中提供了 248 次干预。在 CRCMP 纳入的 NK-1 事件中，14 天内计划外医疗保健的使用减少（6.68% 4.53%， =.02）。当仅考虑恶心的入院时，CRCMP 纳入者的入院人数略有下降（0.63% 0.35%， =.33）。
CRCMP 允许根据患者报告的结局（PROs）和电子病历集成的 SMS 文本问卷实时管理患者报告的 CINV 症状负担。临床药师是管理患者症状的关键团队成员。CRCMP 的纳入显著降低了整体计划外医疗保健的利用。尽管这些变化在数量上很小，但利用 PROs 减少不必要的护理可以为癌症患者提供高价值的护理。
