Leveraging RPM to Enable At-Home Care for High-Risk Cancer Patients

February 05, 2024 - The rapid advancement in digital health technologies post-March 2020 has expanded the boundaries of at-home healthcare. As COVID-19 forced hospitals to deliver more care outside traditional brick-and-mortar facilities, researchers began to examine how virtual care tools can support chronic disease management at home.

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This includes examining how virtual care can enable at-home care in the complex and dynamic world of cancer treatment.

“Providing better care that is centered around the patient, and doing this at a lower cost is really one of the priorities and goals of at-home care,” said Glen Peterson, DNP, ACNP, RN, an associate professor in the Division of Hematology at the University of Colorado (CU Medicine). “And… virtual visits became much more common due to the risks associated with COVID-positive patients coming into health care facilities, especially around patients who are at increased risk, like cancer patients, for example.”

On an episode of the Healthcare Strategies podcast, Peterson described how remote patient monitoring (RPM) and telehealth can enhance patient experience, improve outcomes, and boost the timeliness of cancer care delivery.

Peterson and his team at CU Medicine, along with virtual and in-home cancer care provider Reimagine Care, conducted a study on at-home oncology care for high-risk cancer patients, finding that a technology-based outpatient care approach was “feasible and acceptable.” They presented the abstract at the 2023 American Society of Hematology (ASH) Annual Meeting and Exposition.

RESEARCH FINDINGS

The research, which was supported by CU Innovations at the University of Colorado Anschutz Medical Campus, focused on bone marrow transplant and CAR T-cell therapy patients who face numerous clinical risks.

“These patients are at risk of a variety of serious complications, such as infections in our transplant patients [who] are at risk of graft versus host disease,” Peterson said. “And there are some very specific and unique side effects and potential complications of CAR T-cell therapy, specifically cytokine release syndrome and neurotoxicity.”

Thus, the study examined whether RPM technologies could support early intervention and treatment for these patients and improve outcomes. Ten bone marrow transplant and CAR T-cell therapy patients participated in the study, using RPM for up to 30 days or 90 days post-treatment after being discharged from the hospital.

The patients continuously wore biometric sensors for passive vital sign monitoring and engaged with a chatbot system for health checks and symptom reporting. They were also evaluated by Reimagine Care's virtual care center personnel who were alerted by RPM tools.

The patients, healthcare providers, and caregivers completed surveys about their experience with the program.

Nine of the ten study patients wore devices as intended and responded to chatbot and health survey prompts from April to August 2023. Of 171 wearable alerts, 61.4 percent were clinical, and 38.6 percent were technical. The wearable alerts led to virtual care follow-ups with patients, of which 15 were referred to the patient’s clinical care team and five required subsequent in-person care.

Of the 48 chatbot and survey alerts, 11 were referred to the patient’s clinical care team, and five required in-person follow-up care.

Overall, study participants and healthcare personnel were satisfied with the program and reported positive experiences.

“Patients and caregivers reported that remote patient monitoring made them feel more cared for and that it was helpful and easy to use,” Peterson said. “And it increased their understanding of their care plan.”

Most healthcare personnel felt RPM improved the quality of care, enhanced detection of fever, infection, and symptoms among their patients, were satisfied with the communication from the virtual care team, and felt that RPM should be used more often to manage care at home.

“That's the real benefit of remote patient monitoring — whether patients know it or not — you're able to gather data and assess and evaluate that data to help make decisions that may affect outcomes,” Peterson said.

CRITICAL CONSIDERATIONS FOR AT-HOME CANCER CARE

Though the at-home, RPM-supported cancer care program was well-received, the researchers noted some vital lessons regarding the implementation of the service.

For instance, Peterson stated that RPM needs to be built into a comprehensive care model that includes other necessary resources.

“Remote patient monitoring is additive, and it really takes patient care and safety to the next level,” he said. “But with more data and information, there is some burden that comes with this, you know, staffing resources are needed. There are financial resources that are needed to support what remote patient monitoring has to offer. It's not particularly useful if there's not somebody there to interpret the data and also act on it.”

In the virtual care approach evaluated in the study, Reimagine Care’s virtual care team first gathered patient information and determined whether there were any significant concerns. If they decided a patient needed in-person care, they alerted hematology-focused advanced practice providers at CU Medicine and UCHealth Blood Disorders Center triage nurses, who then conducted the follow-ups. Thus, while RPM and the virtual care teams provided added benefits, the ultimate responsibility for the patient lay with CU Medicine, Peterson stated.

Another consideration for RPM-supported care models is patient engagement. According to Peterson, patients and caregivers need to understand RPM's benefits to remain engaged and use the devices as required. If they can see that these tools support patient safety, enhance access to care, and lessen caregiver burden, they are more likely to be engaged in the program.

Easy access to the virtual care team also helped keep patients and caregivers engaged.

“We had the chatbot system that allowed patients to reach out directly to the virtual care team,” said Peterson. “Also, the virtual care team reach[ed] out to patients if there was either a concern on the biometric monitoring or just on a daily check-in to ask the patient if they're having certain symptoms. So, I think having that interaction was quite engaging for patients.”

In addition to patient engagement, selecting the right technology and vendor partner is critical for the success of these programs. Peterson noted that RPM solutions should enable near-continuous or continuous monitoring and two-way communication with patients to ensure early detection of symptoms. The system should also integrate easily with EHRs to ensure data flows directly to the healthcare provider organization.

However, Peterson emphasized that broader adoption of RPM will not be possible without the support of healthcare payers.

“There is so much potential in this area,” he said. “The financial benefit and cost savings of this approach need more attention to see its full potential.”

With financial backing, RPM use will likely increase as clinical teams appear convinced of its benefits, helping advance the movement to bring healthcare to the home.  

“The aim is to couple remote patient monitoring with more at-home care interventions and keep people out of the hospital and clinics unless they really need to be there,” Peterson said. “There's certainly a benefit in the current state of remote patient monitoring in regard to early detection of side effects and complications and quicker access to care. But in-home care should really be the goal with all of this.”

Editor's note: This article was updated on Feb. 6, 2024, with changes to the description of CU Medicine practitioners who conducted patient follow-ups and Dr. Peterson's title.