Daly Bobby, Cracchiolo Jennifer, Holland Jessie, Ebstein AnnMarie Mazzella, Flynn Jessica, Duck Elaine, Moy Morgan, Walters Chasity B, Giacomazzo Lisa, Huang Jennie, Fahy Rosanna, Bernal Camila, Ackerman Jill, Salvaggio Rori, Begue Aaron, Raj Nitya, Kuperman Gilad, Mao Jun J, Panageas Katherine
Memorial Sloan Kettering Cancer Center, New York, NY.
Mayo Clinic Platform, Rochester, MN.
JCO Oncol Pract. 2024 May;20(5):657-665. doi: 10.1200/OP.23.00565. Epub 2024 Feb 21.
Improving care transitions for patients with cancer discharged from the hospital is considered an important component of quality care. Digital monitoring has the potential to better the delivery of transitional care through improved patient-provider communication and enhanced symptom management. However, remote patient monitoring (RPM) interventions have not been widely implemented for oncology patients after discharge, an innovative setting in which to apply this technology.
We implemented a RPM intervention which identifies medical oncology patients at discharge, monitors their symptoms for 10 days, and intervenes as necessary to manage symptoms. We evaluated the feasibility (>50% patient engagement with symptom assessment), appropriateness (symptom alerts), and acceptability (net promoter score >0.7) of the intervention and the initial effect on acute care visits and return on investment.
During the study period, January 1, 2021, to December 31, 2022, we evaluated 2,257 medical oncology discharges representing 1,857 unique patients. We found that 65.9% of patients discharged (N = 1,489) completed at least one symptom assessment postdischarge and of them, 45.5% (n = 678) generated a severe symptom alert that we helped to manage. Patients expressed high satisfaction with the intervention with a net promoter score of 84%. In preliminary analysis of patients with GI malignancies (n = 449), we found a nonsignificant decrease in 30-day readmissions for the intervention cohort (n = 269) by 5.8% as compared with the control (n = 180; from 33.3% to 27.5%; = .22).
Digital transitional care management was feasible and demonstrated that patients transitioning from the hospital to home have a substantial symptom burden. The intervention was associated with high patient satisfaction but will require further refinement and evaluation to increase its impact on 30-day readmission.
改善癌症患者出院后的护理过渡被视为优质护理的重要组成部分。数字监测有潜力通过改善医患沟通和加强症状管理来优化过渡护理的提供。然而，出院后远程患者监测（RPM）干预措施尚未在肿瘤患者中广泛实施，而这是应用该技术的一个创新场景。
我们实施了一项RPM干预措施，该措施在出院时识别出医学肿瘤患者，对其症状进行10天监测，并在必要时进行症状管理干预。我们评估了该干预措施的可行性（>50%的患者参与症状评估）、适宜性（症状警报）和可接受性（净促进者得分>0.7）以及对急诊就诊的初步影响和投资回报率。
在2021年1月1日至2022年12月31日的研究期间，我们评估了代表1857名独特患者的2257例医学肿瘤出院病例。我们发现，65.9%的出院患者（N = 1489）在出院后至少完成了一次症状评估，其中45.5%（n = 678）产生了严重症状警报，我们帮助对其进行了管理。患者对该干预措施表示高度满意，净促进者得分为84%。在对胃肠道恶性肿瘤患者（n = 449）的初步分析中，我们发现干预组（n = 269）的30天再入院率与对照组（n = 180；从33.3%降至27.5%；P = 0.22）相比有5.8%的非显著下降。
数字过渡护理管理是可行的，并表明从医院过渡到家庭的患者有相当大的症状负担。该干预措施与患者的高满意度相关，但需要进一步完善和评估，以增强其对30天再入院率的影响。
