Pilot Study Finds Remote Monitoring of Patients Undergoing Chemotherapy Feasible

Using technology to monitor outpatients undergoing cancer treatments at home was feasible and led to improvements in care, according to results of a pilot study shared in a poster presentation at JADPRO Live Virtual 2021.

From January 2020 to August 2021, patients who were planning to start an intravenous (IV) anti-cancer treatment plan at Ochsner Health System, had an active patient portal account, and had a smart phone with the Ochsner portal application installed were asked to voluntarily participate in the Chemotherapy Care Companion program. The pilot program monitored patients’ vital signs to identify issues related to or exacerbated by their treatment. Researchers led by Erin Pierce, MSN, APRN, FNP-C, evaluated the feasibility of recruitment into the program, barriers, compliance, and implementation.

Providers placed an Epic Care Companion enrollment order, which triggered a program consent questionnaire sent to the Ochsner online patient portal app on the smartphones of interested patients. Once a patient consented to participate in the program, they received a discount code and instructions for an iHealth digital scale, blood pressure cuff, and ear thermometer from the Ochsner retail store. These items were funded through philanthropy and grants. Once enrolled in the program, the patients were assigned a series of daily tasks, including a symptom survey, weight entry, temperature entry, AM/PM blood pressure, and heart rate reading. Patients received push notification reminders to enter these tasks in the patient portal app. The integrated Bluetooth devices automatically uploaded vital signs to the patient portal and Epic electronic medical record (EMR). When values were found to be outside of a predetermined acceptable limit, electronic escalations of patients for eleven physicians were sent to an Epic In-Basket pool monitored by five advanced practice providers (APPs).

Initially, the providers compared reported vital signs to each patient’s baseline data, but after difficulty identifying patients early enough in the process, vital signs were instead compared to preset data ranges. Examples of interventions by the APPs included identifying the need for urgent care visits, specialist referrals, blood pressure management, and ordering IV fluids and antiemetics.

Of the 209 patients who received enrollment orders, 145 participated in the pilot and 52 declined. Twelve patients were marked deceased. The age range of patients who were active in the pilot was 32 to 85 years. Enrollment lasted until patients no longer wished to participate, when end of treatment was indicated in the EMR, or if they were marked deceased.

Compliance in the program was defined as completion of more than 50% of daily vitals and questionnaire tasks. The rate of compliance among participants was 71.64%.

“Future work hopes to show specific interventions that proactive monitoring can decrease complications and hospitalizations during cancer treatment,” the researchers wrote.

This pilot study was limited by its requirements of smartphone access, basic technology skills, and collection of patient feedback, as well as its small sample size.

Reference

Pierce E, Stott C, Larned Z, et al. Ochsner Health System’s Chemotherapy Care Companion: Technology for monitoring outpatient Oncology patients at home. Clinical poster JL913. Presented at JADPRO Live Virtual, October 7-17, 2021.