Remote symptom monitoring after hospital discharge.
Authors: Daly Robert Michael , Cracchiolo Jennifer R. , Huang Jennie , Hannon Michael , Holland Jessie C. , Begue Aaron , Mazzella AnnMarie , Salvaggio Rori , Polubriaginof Fernanda C. G. , Kuperman Gilad , Roberts Karen , Fahy Rosanna Fiorarancio 
Published: June 2022

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Background: Strategies to improve transitions from the hospital to home for patients with cancer are considered an important component of quality, patient-centered care in oncology. CMS evaluates cancer hospital performance based on the 30-day unplanned hospital readmission rate, and this measure has been endorsed by the National Quality Forum. Nationally, the 30-day readmission rate for oncology patients ranges from 19%-27%. These readmissions come at high psychosocial, physical, and financial costs for patients and caregivers. A remote monitoring intervention that includes frequent contacts with the patient is likely to be effective in improving this transition. Methods: We evaluated the feasibility, acceptability, and perceived value of a mobile health intervention to monitor and manage symptoms of adult medical and surgical oncology patients discharged from an NCI-designated cancer center to home. Patients were monitored for 10 days, which is the median time to readmission for an oncology patient. The technology supporting the program included: 1) a patient portal enabling daily electronic patient-reported outcomes assessments; 2) a pulse oximeter to provide data on blood oxygen level and heart rate; 3) alerts for concerning symptoms; 4) an application to allow staff to review and trend symptom data; 5) a secure platform to support communications and televisits between staff and patients; 6) an advanced feedback report to provide just-in-time patient symptom education. Feasibility and acceptability were evaluated through engagement (goal: > 50% response rate) and symptom alerts and perceived value was measured through a patient engagement survey that included a net promoter score (how likely the patient is to recommend the program to similar patients; goal > 0.7). Results: Between September 27, 2020 to December 31, 2021, the program enrolled 1,091 medical oncology (median age: 63 years, 55% female) and 4,222 surgical oncology patients (median age: 63 years,55% female). Of those enrolled, 65% of medical and 74% of surgical oncology patients participated in home remote monitoring by self-reporting symptom data. This resulted in 2,869 completed symptom assessment from medical and 16,009 completed assessments from surgical patients. Sixty-three percent of medical oncology assessments resulted in a yellow (moderate) or red (severe) symptom alert compared with 26% for surgical oncology patients. Pain was the predominant symptom generating red alerts for medical oncology patients (17%). Fifty-two percent of patients completed the engagement survey, and the net promoter score was 0.82. Conclusions: A remote monitoring program after discharge was feasible, acceptable, and perceived to be of value by oncology patients discharged from a cancer center. Surgical and medical patients have similar response rates but differ in symptom burden. Future work will evaluate the value of a remote symptom monitoring platform in decreasing readmissions.