Remote patient monitoring for high-risk oncology patients: A feasibility implementation study.
Authors: Mazzella Ebstein AnnMarie , Dunnack Yackel Hayley , Daly Robert Michael , Salner Andrew L. , Eanniello Mary Kate , Bernal Camila , Barton-Burke Margaret 
Published: October 2023

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Background: Electronic patient-reported symptom assessment surveys are used in remote monitoring interventions to connect care between the patient and clinical care providers through technology with mobile devices and patient portals. Patient responses to the assessments generate alerts sent to the clinicians who proactively manage the patient’s symptoms at home. This study’s purpose was to determine the feasibility of implementing a remote patient monitoring program in a community-based hospital and cancer institute. Methods: We explored the clinical care models used to assess and manage patient symptoms and the perceptions of hospital stakeholders about the barriers and facilitators of integrating the program into hospital clinical systems. This mixed method study disseminated the Readiness for Implementation survey to hospital stakeholders in September 2022 to obtain estimations of the proportion of positive agreement to hospital culture, learning, leadership, and resources for integrating a remote patient monitoring intervention. The qualitative aspect of the study used purposeful sampling to recruit 52 participants from the surveyed sample and additional administrators, clinical providers, staff nurses, and patients to focus groups. Items from the study’s survey that had the greatest proportion of disagreement were identified as the topics for the interview guide and included: 1) participant perceptions of implementing change 2) the change climate, 3) available resources, and 4) barriers and facilitators of remote patient monitoring for oncology patients. Results: All study results will be presented. Survey results from 53 of 63 hospital stakeholders [84% response rate] validated hospital readiness for implementing remote patient monitoring. Feedback from 8 interviews and 5 focus groups [8 administrators, 5 technology specialists, 14 nurse leaders and staff nurses, 13 oncologists, 5 radiation oncology staff, and 7 patients] averaging 6-20 participants per group, were conducted in January 2023. The transcripts were recorded and transcribed verbatim for analysis using Thematic Analysis and found data saturation in 14 interview sessions. Transcripts were independently coded and sorted into thematic categories. Global themes were summarized across domains and consensus among the study team identified three major themes: Integrating change into hospital systems, Relevance to patient care teams, and Patient and Family Centered Care. Each theme contained several subthemes that were similarly explored. Conclusions: A remote patient monitoring intervention was perceived to be feasible and of value by surveyed hospital stakeholders. Participants reported their insight for integrating change and operationalizing hospital systems to improve a patient’s experience and access to care. Future work will evaluate the investment in technology enhancements and staffing resources.