Association of a Remote Patient Monitoring (RPM) Program With Reduced Hospitalizations in Cancer Patients With COVID-19

Abstract

PURPOSE: The goal of this study was to assess the impact of an interdisciplinary remote patient monitoring (RPM) program on clinical outcomes and acute care utilization in cancer patients with COVID-19. METHODS: This is a cross-sectional analysis following a prospective observational study performed at Mayo Clinic Cancer Center. Adult patients receiving cancer-directed therapy or in recent remission on active surveillance with polymerase chain reaction–confirmed SARS-CoV-2 infection between March 18 and July 31, 2020, were included. RPM was composed of in-home technology to assess symptoms and physiologic data with centralized nursing and physician oversight. RESULTS: During the study timeframe, 224 patients with cancer were diagnosed with COVID-19. Of the 187 patients (83%) initially managed in the outpatient setting, those who did not receive RPM were significantly more likely to experience hospitalization than those receiving RPM. Following balancing of patient characteristics by inverse propensity score weighting, rates of hospitalization for RPM and non-RPM patients were 2.8% and 13%, respectively, implying that the use of RPM was associated with a 78% relative risk reduction in hospital admission rate (95% CI, 54 to 102; P = .002). Furthermore, when hospitalized, these patients experienced a shorter length of stay and fewer prolonged hospitalizations, intensive care unit admissions, and deaths, although these trends did not reach statistical significance. CONCLUSION: The use of RPM and a centralized virtual care team was associated with a reduction in hospital admission rate and lower overall acute care resource utilization among cancer patients with COVID-19.

Effectiveness of a digital telemonitoring platform for cancer care of older patients: The ConnectElderlyPatientToDoctor study

“…Remote monitoring has a clear impact on unscheduled hospitalizations, as there were no differences between the YP and OP groups. Pritchett et al also reported the positive impact of remote monitoring on unscheduled hospitalizations 16 . In fact, the use of remote monitoring was associated with a 78% relative risk reduction in hospital admission in their study 16 …”

“…Pritchett et al also reported the positive impact of remote monitoring on unscheduled hospitalizations. 16 In fact, the use of remote monitoring was associated with a 78% relative risk reduction in hospital admission in their study. 16 To our knowledge, this is the first study that assesses the use of PRO-based tolerance as a predictive factor of treatment response in OPs.…”

“…16 In fact, the use of remote monitoring was associated with a 78% relative risk reduction in hospital admission in their study. 16 To our knowledge, this is the first study that assesses the use of PRO-based tolerance as a predictive factor of treatment response in OPs. We demonstrated here a significant 80% reduction in the risk of progression in OPs with good first-month tolerance.…”

Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management

“…In a retrospective analysis of patients who engaged in the COVID-19 RPM program, we observed a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), ICU admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those patients who were enrolled to the program but did not engage with the RPM technology ( 56 ). Further retrospective evaluation found that cancer patients with COVID-19 managed with RPM had a significantly lower hospital admission rate (2.8% vs. 13%, P = 0.002) compared with those managed without the program ( 68 ). Similar results were observed in a prospective, randomized, controlled trial of patients with chronic conditions who were monitored with or without RPM upon hospital discharge.…”

“…Outcomes associated with RPM reported in the literature have been mixed, with most strategies having been shown to positively impact patient management ( 44 ). Prior evaluations at Mayo Clinic have found that the use of RPM for supportive care for patients’ acute and chronic conditions has been associated with positive trends in acute care utilization, clinical outcomes, and total cost of care ( 56 , 67 , 68 ). In a retrospective analysis of patients who engaged in the COVID-19 RPM program, we observed a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), ICU admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those patients who were enrolled to the program but did not engage with the RPM technology ( 56 ).…”