We are used to sophisticated, complex technological tools providing improved patient clinical outcomes, but it is unexpected to see common, basic technological tools that are used by all of us on daily basis (the internet, email, and cell phones) make significant impacts on patients’ lives and the cost of healthcare. The following research studies exemplify simple, innovative approaches that resulted in meaningful change, improved quality of life, and significant cost savings.
Simple Technology Tools Boost Cancer Survival Rates
A clinical trial, conducted by Dr. Ethan Basch at the Sloan Kettering Cancer Center in New York from September 2007 to January 2011, consisted of 766 patients receiving chemotherapy for metastatic solid tumors. The goals of the study were: (1) to provide a quick, easy way to report complications in “real-time”, so they could be treated immediately, rather than waiting until the next office visit; and (2) to improve the patient’s quality of life.
The patients were randomly assigned to two groups: (1) the normal care group (NCG), which followed standard procedures for monitoring symptoms (phone calls or reporting during office visits); and (2) the patient reported outcomes (PRO) group, who reported 12 common cancer and chemotherapy symptoms and side effects at least weekly using a web-based questionnaire based on the National Cancer Institute’s Common Terminology Criteria for Adverse Effects. The median age of the patients was 61, with the oldest being 91 years old. Some had minimal computer skills, but they found the web-based platform easy to use.
Patients do not typically report all symptoms and side effects of chemotherapy for a variety of reasons: they feel symptoms are normal and “to-be-expected”, they don’t want to complain, they don’t have time to discuss them during the visit, or they simply forget about the symptoms by the time they have their office visit. Consequently, about 50% of the patients typically wind up in the emergency department (ED) or are admitted to the hospital after beginning chemotherapy. Likewise, because physicians don't hear about many of the serious side effects, they under-report adverse effects by as much as 50%.
In this study, when the PRO patients reported symptoms using the web-based questionnaire, it generated an email to a nurse, who would contact them, if needed (77% of the time) and make immediate changes to their treatment plan, medications, chemotherapy dosages, or provide needed additional supportive medications for nausea, diarrhea, constipation, pain, etc. In addition, they would provide additional proactive symptom management techniques, counseling, and referrals, as needed.
The results of the study showed that patients in the PRO group: (1) were willing to report their symptoms; (2) had reduced emergency department visits and hospital admissions; (3) reported an improved quality of life; (4) led a more active life-style; (5) and were able to stay on chemotherapy almost 2 months longer (8.2 months vs. 6.3 months). While these results were somewhat anticipated, there was another outcome that was not specifically expected – the median cancer survival rate for the PRO patients was 5 months longer than the NCG patients (31.2 months vs. 26 months). While that may not seem like much, it provides greater benefit than many targeted drugs for metastatic cancer and more importantly, those extra months mean everything to patients suffering from terminal cancer and to their loved ones.
This approach is easy to implement and is a low-cost way to reduce suffering, improve the quality of life, increase the survival rate, and save millions of dollars in preventable emergency department visits and hospital admissions.
Dr. Basch is now leading a national trial involving 1,000 patients being treated in community oncology practices around the country. The tool is getting even simpler and more accessible, since the questionnaire and real-time reporting can now be done using a cell phone. “We have limited time to see a lot of people as oncologists,” he said. “But we can harness technology to improve the quality of how we practice and to bring us closer to our patients.”
A Simple Technological Tool Enables ED Physicians to Discharge Patients Quicker
Increasing throughput times is an ongoing challenge for all emergency departments (EDs). The Canadian province of Ontario provides financial incentives for EDs meeting defined length-of-stay targets and the Centers for Medicare and Medicaid Services in the U.S. requires hospitals to report and address ED throughput times as an important quality indicator.
A randomized controlled study was conducted by ED physicians at the Sunnybrook Health Sciences Centre, an affiliated teaching hospital of the University of Toronto, to assess the effect “push-alert notifications” of troponin results, sent to physicians smartphones, would have on the disposition decision time for patients being treated in the ED with chest pain.
Troponin levels are drawn for patients who present to the ED with chest pain. Elevated levels indicate a heart attack and help with the decision to admit a patient, while lower levels are helpful in making a discharge decision. So, the quicker physicians see the results, the quicker they can determine a disposition decision.
In this study of 1,554 patients, physicians agreed to receive the troponin level results as push-alert notifications on their smartphone or as the standard “pull” results, which required them to check the medical record when the physician had time.
The results showed that physicians who received the push-notifications on their smartphones determined a disposition decision 26 minutes faster than those who received “pull” results on the medical record. However the patient length-of-stay was not significantly reduced, because of other factors beyond the physician’s control, such as waiting for lab, x-ray, or CT reports or waiting for treatments by nurses or other ancillary staff members.
Theoretically, if lab, x-ray, and CT scan results were also provided by push-notifications, the “push” technology provided by the smartphone would have the ability to increase the overall throughput times and thereby reduce the overall length-of-stay.
The use of the smartphone is becoming much more prevalent and essential in healthcare. However, we need to remember that cybersecurity is a key concern. Cybersecurity threats exist, if mobile devices are not totally secure. This needs to be a critical aspect of any ongoing process to provide push-notification results.