The complex needs of patients with cancer require a more proactive approach to their care. Ochsner Health, Ochsner Cancer Institute in Louisiana implemented a program—Chemotherapy Care Companion—to identify and meet patients’ needs in real time.
This blog post is the fourth of a five-part series highlighting the achievements of the 2022 ACCC Innovator Award winners before their in-depth sessions at the ACCC 39th National Oncology Conference. You can learn more about the innovations being recognized this year and the people who pioneered them by joining ACCC in West Palm Beach, Fla., on October 12-14, 2022.
The complex needs of patients with cancer require a more proactive approach to their care. Ochsner Health, Ochsner Cancer Institute in Louisiana implemented a program—Chemotherapy Care Companion—to identify and meet patients’ needs in real time. Developed in January 2020, Chemotherapy Care Companion allows providers to remotely monitor patients on intravenous or oral anti-cancer treatment to discover the issues these patients may experience during and after treatment appointments, including fluctuations in vitals.
At the onset of the program, the team at Ochsner Cancer Institute had two goals:
Zoe Larned, MD, system chair of Hematology and Oncology, took the lead on the project, with the support of the cancer institute’s advanced practice provider (APP) team, including Erin Pierce, MSN, APRN, FNP-C, nurse practitioner. In addition to improving the patient experience and patient outcomes, Pierce and Dr. Larned believe that Chemotherapy Care Companion decreases patients’ healthcare costs. “Remote patient monitoring is something that every patient with cancer should have access to,” Dr. Larned said.
Program Implementation
Prior to creating the Chemotherapy Care Companion program, Ochsner Cancer Institute embedded a daily urgent care clinic within its facility. “We wanted patients to be able to reach out if they had issues that did not require a visit to an emergency department,” Dr. Larned said. By using the urgent care, Ochsner providers could easily integrate Chemotherapy Care Companion within its established workflow to quickly see patients for triage appointments, where APPs offer same-day appointments for uncontrolled symptoms related to treatment, such as nausea, vomiting, diarrhea, fever, or need for pain control. Patients are able to get labs and receive additional infusion services like fluids and antiemetics if needed.
The next step was implementing remote patient monitoring. To enroll, patients use a smartphone to complete a form on their online patient portal app. Upon completion of program enrollment and informed consent, patients are provided an iHealth digital scale, blood pressure cuff, and ear thermometer. “A fluctuation in a baseline pulse could be a sign of dehydration or the start of an infection,” Dr. Larned said. Twice daily patients are required to report their daily weight and temperature, blood pressure and heart rate, and any symptoms they may be experiencing and to complete a questionnaire. A reminder embedded in the patient portal app ensures that patients do not forget to input their vitals. Any abnormal vitals or questionnaire responses trigger a review by an APP.
This information is subsequently uploaded from the patient portal app to Ochsner Cancer Institute’s electronic health record, where the data is analyzed by an APP. “Multiple weeks may pass between each meeting with a patient and their care provider, and serious issues could occur in that timespan,” Pierce explained. “This is why it’s important for our APPs to be able to monitor patients while they are at home so that we can intervene if needed."
This pilot program began at the Ochsner Cancer Institute in New Orleans, La., and has since expanded into Ochsner Health’s other oncology locations. Initially, the team sourced Chemotherapy Care Companion’s base capital through philanthropic donors. Because these funding sources are not permanent, the team transitioned to grants, and they were able to obtain an excellence grant for $25,000. In the future Pierce and Dr. Larned hope that payers will cover program costs.
Programmatic Successes
Preliminary data, collected from January 2020 through December 2021, show a 33 percent reduction in the number of ED visits and hospital admissions for patients enrolled in the program, compared to the patients who were not. And its patient compliance rate hit nearly 70 percent. Considering that half of the patients enrolled in the program have Stage 4 disease, this program has seen significant success. “I think this is a worthwhile program,” Dr. Larned said. “And the expectation among all cancer programs should be to provide this kind of remote monitoring for our patients.”
Dr. Larned is excited to attend the ACCC 39th National Oncology Conference this fall, where she will share more on how the team created and implemented the Chemotherapy Care Companion program, including additional pilot study findings and future plans. “We need to share our innovative ideas,” Dr. Larned said. “By networking and seeing what other people are doing, you are able to expand what your own cancer programs can do.” To learn more about implementing remote patient monitoring in your cancer program or practice, including the technology and support staff needed to find success, register and attend the ACCC National Oncology Conference.
