Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Netw Open. 2024 Jun 3;7(6):e2416570. doi: 10.1001/jamanetworkopen.2024.16570.
Patients of Memorial Sloan Kettering Cancer Center in New York, New York, are now offered a choice of either in-person or remote telehealth visits for radiation oncology care. However, safety and satisfaction among patients receiving treatment with fully remote physician management is unclear.
To analyze patient safety and satisfaction, financial implications, and environmental consequences associated with fully remote management among a cohort of patients treated with radiotherapy.
DESIGN, SETTING, AND PARTICIPANTS: This single-institution retrospective cohort study was performed at Memorial Sloan Kettering Cancer Center, with patients treated with radiation who opted for fully remote management between October 1, 2020, and October 31, 2022. Data on patient safety events were prospectively collected with an in-house quality improvement reporting system. Patient satisfaction surveys were distributed electronically before, during, and after treatment. Patient transportation costs and environmental consequences were estimated based on differences in travel distance. Data analysis was performed from March 14 through September 19, 2023.
Radiotherapy with fully remote physician management.
Satisfaction rates among patients opting for fully remote management were analyzed via surveys administered electronically after visits with clinicians. Patient safety events, defined as staff-reported actual events and near misses that had the potential to affect patient care, were reviewed. Rates and types of safety events were analyzed and compared with patients treated by onsite clinicians. Distances between patient home zip codes and treatment site locations were compared with estimated cost savings and decreased emissions.
This study included 2817 patients who received radiation oncology care with fully remote physician management. The median age of patients was 65 (range, 9-99) years, and more than half were men (1467 [52.1%]). Of the 764 safety events reported, 763 (99.9%) did not reach patients or caused no harm to patients. Nearly all survey respondents (451 [97.6%]) rated patient satisfaction as good to very good across all domains. For treatment with fully remote physician management, out-of-pocket cost savings totaled $612 912.71 ($466.45 per patient) and decreased carbon dioxide emissions by 174 metric tons.
In this study, radiation oncology care provided by fully remote clinicians was safe and feasible, with no serious patient events. High patient satisfaction, substantial cost savings, and decreased environmental consequences were observed. These findings support the continuation of a fully remote management option for select patients in the post-COVID-19 era.
纽约州纽约市纪念斯隆凯特琳癌症中心的患者现在可以选择亲自就诊或远程远程医疗就诊进行放射肿瘤治疗。然而，接受完全远程医生管理治疗的患者的安全性和满意度尚不清楚。
分析一组接受放射治疗的患者中，完全远程管理的患者安全性和满意度、经济影响和环境后果。
设计、地点和参与者：这是一项单机构回顾性队列研究，在纪念斯隆凯特琳癌症中心进行，患者于 2020 年 10 月 1 日至 2022 年 10 月 31 日期间选择完全远程管理接受放射治疗。使用内部质量改进报告系统前瞻性收集患者安全事件数据。在治疗前、治疗中和治疗后通过电子方式分发患者满意度调查。根据旅行距离的差异估计患者交通费用和环境后果。数据分析于 2023 年 3 月 14 日至 9 月 19 日进行。
完全远程医生管理下的放射治疗。
通过在与临床医生就诊后电子方式进行的调查，分析选择完全远程管理的患者的满意度。审查了定义为员工报告的实际事件和可能影响患者护理的未遂事件的患者安全事件。分析并比较了安全事件的发生率和类型，以及与由现场临床医生治疗的患者。将患者家庭邮政编码和治疗地点之间的距离与估计的节省成本和减少排放进行比较。
这项研究包括 2817 名接受完全远程医生管理的放射肿瘤治疗的患者。患者的中位年龄为 65 岁（范围 9-99 岁），超过一半是男性（1467 [52.1%]）。报告的 764 起安全事件中，763 起（99.9%）未波及患者或未对患者造成伤害。几乎所有调查对象（451 [97.6%]）都在所有领域对患者满意度评价为好到非常好。对于完全远程医生管理的治疗，自付费用节省总计 612912.71 美元（每位患者 466.45 美元），减少了 174 公吨的二氧化碳排放量。
在这项研究中，由完全远程临床医生提供的放射肿瘤治疗是安全且可行的，没有发生严重的患者事件。观察到患者满意度高、成本大幅节省和环境影响降低。这些发现支持在 COVID-19 后时代为选定患者继续提供完全远程管理选择。
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