New System May Help Keep High-Risk Cancer Patients Out of Hospital

A system that alerts doctors when high-risk cancer patients are admitted helped reduce hospital readmissions: © stock.adobe.com.

When coupled with targeted interventions, an electronic health record alert lowered 30-day readmissions and length of hospital stays for patients with high-risk metastatic cancer, according to a real-world study published in JCO Oncology Practice.

“This dual notification ensures that the intervention is put into motion as soon as possible,” Michelle M. Chin of the University of Central Florida College of Medicine, said in the news release. “The four-part interventions included coordination of care, inpatient consultation, patient education and symptom management, and postdischarge follow-up.”

The electronic health record alert identifies high-risk metastatic cancer patients entering the hospital. The protocol automatically flags these patients at admission using factors like recent hospital stays, oxygen or IV needs, antibiotic use, or signs of malnutrition. Once flagged, staff verify the cancer diagnosis and connect the care team with a concierge scheduler to coordinate next steps.

In a comparison of outcomes between 600 patients who received the intervention and 103 baseline patients, those in the intervention group experienced meaningful improvements. Thirty-day readmission rates dropped from 41.2% to 31.8%, while average hospital stays shortened by 1.14 days, from 5.65 to 4.51 days.

“[This work] is exciting for patients with advanced cancer [who have many hospitalizations and who, once admitted, are at high risk for readmission],” Dr. Debra Patt said in the news release. “This is a great way we use digital healthcare tools, like clinical decision support, to improve patient outcomes.”

Patt is a breast cancer specialist in Austin, Texas, and executive vice president at Texas Oncology. She led a recent study that showed remote symptom monitoring with electronic patient-reported outcomes can be successfully implemented at cancer practices.

In addition, she explained that electronic health record-based interventions can help prevent a common issue in cancer care: patients with advanced disease are often hospitalized without their oncology team being aware. “A patient may not have a follow-up scheduled with their oncologist for a couple of weeks. By clustering support around these patients, we’re able to influence the likelihood of readmission,” Patt said.

Patt emphasized that the patient education component of the intervention was especially valuable. “Organizations are sometimes reluctant to make investments in patient education, but you’re empowering them and their caregivers to help you get them what they need,” she said.

She also found the reduction in readmissions and length of stay to be meaningful. “If the dream of modern cancer therapy is that patients have control of their cancer, and cancer therapy doesn’t impede their livelihood, we can say that patients that get to stay out of the hospital and are in the hospital for shorter durations of time get to live that dream better,” she said.

Chin noted the results were encouraging on several levels. “It’s a proof of concept that patients can be identified quickly and effectively in a large hospital system, and we were able to mobilize our existing resources — concierge medicine, palliative care, et cetera — in a timely manner,” she said. “We hope this will help support cancer patients better as they leave the hospital and go back to the care of their primary oncologists.”

However, implementing these interventions successfully requires more than just good intentions, Patt added. It takes organizational awareness, a structured education plan, coordination between doctors and nurses, and updates to workflows. “If you didn’t think through that, you may not enjoy the same benefits of reduced hospitalization,” she said.

Reference

1. "EHR-Based Intervention Helps Advanced Cancer Patients Stay Out of the Hospital, Real-World Study Finds," Oncology News Central. July 10th

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