Telehealth visits generate significant cost savings for adult cancer patients younger than 65, according to a new research article.

Cancer is among the most expensive medical conditions to treat in the United States, according to the National Cancer Institute (NCI). Direct costs include multiple types of treatments such as surgery, chemotherapy, and radiation therapy. Indirect costs include travel expenses and lost employment productivity for clinical visits.

The new research article, which was published by JAMA Network Open, examines indirect cost savings for more than 11,000 patients with more than 25,000 telehealth visits at Moffitt Cancer Center, the only NCI-designated Comprehensive Cancer Center in Florida. The telehealth visits were conducted from April 1, 2020, to June 30, 2021.

The study accounts for two indirect costs: roundtrip car travel and loss of productivity because of travel and the additional time associated with in-person visits compared to telehealth visits. The researchers divided visits in three categories: new visits for patients who had not received previous care at the cancer center, established visits for patients who had received previous care at the cancer center but were referred to a new subspecialty for consultation, and follow-up visits for patients who had visits for care in the same subspecialty they had received previous care at the cancer center.

The study has several key data points:

• Based on two cost models for telehealth visits, the mean total saving in indirect costs ranged from $147.4 to $186.1 per visit
   
• For new and established telehealth visits, the mean total cost savings per visit ranged from $176.6 at $0.56 per mile of travel to $222.8 at $0.82 per mile of travel
   
• For follow-up telehealth visits, the mean total cost savings per visit was $141.1 at $0.56 per mile of travel to $178.1 at $0.82 per mile of travel
   
• About 3,790,000 roundtrip miles were avoided, which generated more than 75,000 hours of savings in total driving time
   
• Telehealth visits generated about $1,170,000 savings in lost income because of driving time and about $467,000 savings in lost productivity because of visit time
   
• The mean driving cost savings per telehealth visit ranged from $83.2 at $0.56 per mile of travel to $122.0 at $0.82 per mile of travel

“These findings suggest that telehealth saves time, travel, and money for patients, which could improve care delivery and may reduce the financial toxicity of cancer care,” the study’s co-authors wrote.

INTERPRETING THE DATA

The indirect cost savings from cancer telehealth visits are substantial, the study’s co-authors wrote. “Telehealth was associated with a total savings of 3,789,963 roundtrip travel miles, which equates to traveling 152.2 times around the earth, and a total savings of 75,055 roundtrip drive hours, which equates to 8.6 calendar years. An additional 3.4 calendar years (29,626 hours) were saved in clinic visits by using telehealth.”

Travel is a significant factor in cancer care, the co-authors wrote. “The burden of travel has been identified as an important factor that can change access to diagnosis, treatment of cancer and participation in clinical trials. Transportation is a key determinant of healthcare access and has been identified as an important source of out-of-pocket nonmedical costs for patients receiving cancer care. Patients without adequate transportation are more likely to miss appointments and rely on emergency department care, and there is substantial variability in the estimated parking costs throughout cancer treatment.”

Rural cancer patients could benefit most from telehealth, the co-authors wrote. “A recent study noted that the number of rural hospitals has decreased over the last decade, resulting in almost double the number of people living outside a 60-minute radius of major hospitals and longer drive times to receive care. Thus, telehealth could be beneficial among rural patients in particular.”

The study underestimates the indirect cost savings generated by telehealth cancer care, the co-authors wrote. “We did not consider the cost savings of telehealth for cancer caregivers. Caregivers for patients with cancer spend substantial time and effort to coordinate and attend appointments with patients. … Therefore, savings from telehealth would be even higher if caregivers’ savings from lost productivity were accounted for, especially when telehealth has the ability for multiple caregivers to join the same appointment from various geographical locations.”

The post ‘TELEHEALTH SAVES TIME, TRAVEL, AND MONEY FOR PATIENTS,’ CANCER RESEARCHERS FIND appeared first on Dr. Miltie.

January 10, 2023

Krupal B. Patel, MD, MSc^1,2; Kea Turner, PhD, MPH³; Amir Alishahi Tabriz, MD, PhD, MPH³; et alBrian D. Gonzalez, PhD³; Laura B. Oswald, PhD³; Oliver T. Nguyen, MSHI³; Young-Rock Hong, PhD, MPH⁴; Heather S. L. Jim, PhD³; Anthony C. Nichols, MD⁵; Xuefeng Wang, PhD⁶; Edmondo Robinson, MD, MBA^7,8; Cristina Naso, MEd⁹; Philippe E. Spiess, MD, MS^9,10

Author Affiliations Article Information

JAMA Netw Open. 2023;6(1):e2250211. doi:10.1001/jamanetworkopen.2022.50211

Key Points

Question  What are the estimated cost savings of using telehealth among patients with cancer?

Findings  This economic evaluation of cost savings from completed telehealth appointments included 11 688 patients younger than 65 years, with 25 496 telehealth visits at a National Cancer Institute–Designated Comprehensive Cancer Center from April 1, 2020, to June 30, 2021. According to cost models, the estimated mean total cost savings ranged from $147.4 to $186.1 per visit.

Meaning  These findings suggest that telehealth saves time, travel, and money for patients, which could improve care delivery and may reduce the financial toxicity of cancer care.

Abstract

Importance  Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth.

Objective  To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery.

Design, Setting, and Participants  An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute–Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021.

Main Outcomes and Measures  The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract–level median hourly wages were used.

Results  The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile.

Conclusions and Relevance  In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.

Introduction

Financial toxicity includes both objective financial burden (ie, costs) and subjective financial distress.^1,2 Costs of cancer care include: direct cost of care (cost sharing through higher deductibles, copayments, coinsurance, and even entire cost of care for uninsured patients) and indirect costs of care (lost productivity and cost of driving to and from appointments).^1,3 Patients with cancer have greater time-based costs than those without cancer (eg, time spent traveling back and forth to appointments and time spent receiving medical care).^4–6 Strategies are needed to reduce the direct and indirect costs of cancer care delivery.

The rapid adoption of telehealth during the COVID-19 pandemic has allowed patients to receive care in a location that is convenient for them, which may reduce the costs of cancer care. To date, there has been limited research regarding the cost savings of telehealth among patients with cancer. The COVID-19 pandemic is providing a unique opportunity to estimate the potential cost savings of telehealth in oncology care.⁷ Although it is well established that patients with cancer experience substantial financial toxicity, few studies have explored the indirect costs that they face. Thus, this study focused specifically on an oncologic population from a comprehensive cancer center with a substantially large sample size to estimate the indirect cost savings (driving costs and lost productivity) from telehealth visits.

Methods

This was an economic evaluation estimating cost savings from completed telemedicine visits at Moffitt Cancer Center (MCC), the only National Cancer Institute (NCI) –Designated Comprehensive Cancer Center in Florida. Data from telehealth visits were collected from April 1, 2020, to June 30, 2021. All patients aged between 18 and 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. All patients were offered telehealth if deemed appropriate by the clinical team. Telehealth visits were not offered to patients who needed physical examinations beyond what can be assessed during a telehealth visit. Patients who presented in person for chemotherapy infusion and/or radiation treatment were excluded from the analysis. This study was exempt from MCC institutional review board approval with a waiver of informed consent from patients because the study was deemed low risk. This study used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guideline.⁸

Due to the COVID-19 pandemic, implementation of telehealth at MCC was accelerated in March 2020. Telehealth was defined as care delivered through a videoconferencing platform in real time. Starting in April 2020, MCC instituted videoconferencing for their telehealth visits. Patient visits were defined as new, established, or follow-up. New patient visits were patients not having received any previous medical care from MCC; established patient visits had received care at MCC previously but were referred to a new subspecialty for consultation; and follow-up patient visits were seen at MCC for follow-up care by clinicians in the same subspecialty they had previously received care from.

Statistical Analysis

We assessed patient time, travel, and indirect cost savings from using telehealth for cancer care delivery (Figure 1). Analyses were guided by the framework recommended by Sanders and colleagues⁹ for assessing the time and transportation costs of patients. Time savings were calculated as the difference between the roundtrip time required to travel from each patient’s home address to an in-person consultation at MCC, plus in-person consultation time vs the time required to attend a telehealth visit from home (ie, time savings = roundtrip drive time + [time for in-person consultation – time for telehealth visit]). Travel savings were calculated as the roundtrip driving distance in miles from each patient’s home address to an in-person consultation at MCC. Indirect cost savings were calculated as the roundtrip costs associated with traveling from each patient’s home address to an in-person consultation at MCC. This included 2 components: the costs of travel and the potential loss of productivity due to the medical visit.

The American Community Survey (ACS)¹⁰ was used to determine census tract–level data for hourly median income per year. The census tract income data were then matched to the patient’s address. This analysis focused on patients younger than 65 years, because these patients were more likely to be employed full time than those aged 65 years or older.

Two different models were generated with a combination of 2 different mileage rates and hourly wage rates determined via ACS census tract level data. Driving distance traveled in miles was calculated in October 2021 by Buxton Company,¹¹ an analytics organization that uses Alteryx’s¹² analytic platform to provide geospatial data. Briefly, the locations are geocoded, and distance is calculated between the 2 geocoded locations by finding the route that results in the least amount of drive time between the 2 locations.

Calculations for different models were conducted using R (R Project for Statistical Computing).¹³ Details are available in the eMethods in Supplement 1. Data were analyzed from April 2020 to June 2021.

Results

A total of 25 496 telehealth visits for 11 688 patients were conducted for patients aged between 18 and 65 years during the study period. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits (Figure 2A). The eTable in Supplement 1 highlights the demographics of the telehealth visits. Median (IQR) age was 55.0 years (46.0-61.0) among the telehealth visits, with 15 663 visits (61.4%) being women, 18 443 visits (72.3%) having private insurance, and 18 360 (72.0%) visits by White non-Hispanic individuals. In travel, an estimated 3 789 963 roundtrip miles (804 969 for new or established visits and 2 984 994 for follow-up visits) were saved, equating to 75 055 hours (15 422 new or established visits and 59 633 for follow-up visits) of savings in total driving time. Per visit, telehealth was associated with mean (SD) savings of 148.6 (143.7) roundtrip travel miles and 2.9 (2.3) hours of roundtrip driving time (Table 1, Figure 2B and 2C). An additional 29 626 hours of in-clinic visits were saved by using telehealth with a mean (SD) savings of 1.2 (0.13) hours per visit (Figure 2D). For new or established visits, telehealth was associated with mean (SD) savings of 177.6 (161.6) roundtrip travel miles, 3.4 (2.6) hours of roundtrip driving time and 1.5 (0.0) hours of in-clinic time per visit (Figure 2B, 2C, and 2D). For follow-up visits, telehealth was associated with mean (SD) savings of 142.4 (138.8) roundtrip travel miles, 2.8 (2.3) hours of roundtrip driving time and 1.1 (0.0) hours of in-clinic time per visit (Figure 2B, 2C, and 2D).

Telehealth was associated with an estimated $1 170 160 savings in lost productivity (income) due to driving time, $467 247 savings in lost productivity due to visit time, and $1 637 407 total savings in lost productivity (Table 2, Figure 2B, 2C, and 2D). For new or established visits, the following savings were noted: $245 113 savings in lost productivity due to driving time, $104 522 savings in lost productivity due to visit time, and $349 655 total savings in lost productivity. For follow-up visits, the following savings were noted: $925 027 savings in lost productivity due to driving time, $362 725 savings in lost productivity due to visit time, and $1 287 752 total savings in lost productivity. Mean (SD) savings in lost productivity per visit due to driving time were $45.9 (41.5) per visit overall, and $54.1 (47.9) for new or established visits and $44.1 (39.7) for follow-up visits (Table 2, Figure 3A). Mean (SD) savings per visit in lost productivity due to visit time was $18.3 (5.9) per visit overall, and $23.1 (6.9) for new or established visits and $17.3 (5.1) for follow-up visits. Estimated mean (SD) total savings per visit from lost productivity was $64.2 (43.6) per visit overall, $77.2 (50.6) for new or established visits, and $61.4 (41.4) for follow-up visits. Total driving-cost savings ranged from $2 122 379 at $0.56/mile (Figure 3B) to $3 107 777 at $0.82/mile (Figure 3C). For new or established visits, total driving-cost savings were $450 782 at $0.56/mile to $660 074 at $0.82/mile, while for follow-up visits, total driving-cost savings were $1 671 597 at $0.56/mile to $2 447 695 at $0.82/mile. According to cost models, the mean (SD) driving cost savings per visit ranged from $83.2 ($80.5) at $0.56/mile to $122.0 ($118.0) at $0.82/mile (Table 2, Figure 3B and 3D). For new or established visits, the mean (SD) driving cost savings per visit ranged from $99.6 ($90.5) at $0.56/mile to $146.0 ($132.6) at $0.82/mile, and for follow-up visits, the mean (SD) cost savings per visit was $79.7 ($77.7) at $0.56/mile to $116.7 ($113.8) at $0.82/mile. According to cost models, the mean (SD) total cost savings per visit ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile (Table 2, Figure 3B and 3D). For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile.

Discussion

This economic evaluation study uses a large data set collected at an NCI-Designated Comprehensive Cancer Center to estimate patients’ savings from using telehealth. From April 1, 2020, to June 30, 2021, a total of 25 496 telehealth visits were conducted. Telehealth was associated with a total savings of 3 789 963 roundtrip travel miles, which equates to traveling 152.2 times around the earth, and a total savings of 75 055 roundtrip drive hours, which equates to 8.6 calendar years. An additional 3.4 calendar years (29 626 hours) were saved in clinic visits by using telehealth. Depending on the visit types, mean savings in lost productivity per visit due to driving time ranged from $44.1 to $54.1, mean savings in lost productivity due to visit time ranged from $17.3 to $23.1, and mean total savings in lost productivity per visit ranged from $61.4 to $77.2. Mean driving cost savings per telehealth visits ranged from $79.71 to $146.0 depending on visit type and model used. Mean total cost savings per visit ranged from $141.1 to $222.8 depending on the visit type and model used.

Some of the main arguments for implementing telehealth are to increase access to care, patient convenience, and cost savings in outpatient clinics.¹⁴ Telehealth may also provide an opportunity to reduce emergency department visits, readmissions, and patient mortality.¹⁴ As patients’ financial costs of cancer care increase, telehealth may reduce their burden of travel including costs associated with parking and lodging, and lost income from missing work.

The burden of travel has been identified as an important factor that can change access to diagnosis, treatment of cancer and participation in clinical trials.^15,16 Transportation is a key determinant of health care access and has been identified as an important source of out-of-pocket nonmedical costs for patients receiving cancer care.¹⁷ Patients without adequate transportation are more likely to miss appointments and rely on emergency department care,¹⁵ and there is substantial variability in the estimated parking costs throughout cancer treatment.¹⁸ In addition, a recent study noted that the number of rural hospitals has decreased over the last decade, resulting in almost double the number of people living outside a 60-minute radius of major hospitals and longer drive times to receive care.¹⁹ Thus, telehealth could be beneficial among rural patients in particular.²⁰

In the models previously mentioned, we did not consider the cost savings of telehealth for cancer caregivers. Caregivers for patients with cancer spend substantial time and effort to coordinate and attend appointments with patients. In 2020, 53 million individuals were caregivers, 6% of whom were caregivers for patients with cancer. The vast majority of caregivers (80%) help with transportation; 18% report high financial strain; and 45% have experienced at least 1 financial impact as a result of caregiving.²¹ Although the current study was focused on indirect cost savings from patients’ perspectives, future studies should include caregivers’ indirect cost savings as often patients and caregivers function as a unit and share expenses. Therefore, savings from telehealth would be even higher if caregivers’ savings from lost productivity were accounted for, especially when telehealth has the ability for multiple caregivers to join the same appointment from various geographical locations.

Although telehealth offers considerable cost savings to patients with cancer, it is well documented that telehealth adoption is affected by the digital divide. Factors associated with financial toxicity (eg, age, insurance, race, and education) are also associated with the digital divide.²² Future studies are needed to address inequities in telehealth uptake. Additionally, telehealth requires substantial infrastructure costs and investments from health systems with buy-in from administrators and clinicians to ensure high patient satisfaction.²³

Limitations

Our study has several limitations. This analysis was retrospectively conducted at a tertiary/quaternary referral center, and so roundtrip travel distances may be higher than usual because this is a destination center for cancer care. Our assumption of employment rates and incomes for patients younger than 65 years may vary. Additionally, a percentage of patients on active treatment or following treatment may not be fully employed given their functional status, thus affecting the savings from lost productivity. Because we were unable to accurately capture employment among older adults, patients aged over 65 years were excluded; however, future studies should examine cost savings in this population. Cost savings due to lost productivity assumed that all patients are nonsalaried and the loss due to travel time and hours of visit time could not be made up for. Therefore, the savings in this study might be considered a maximum amount of lost productivity. This study only considered telehealth visits that were completed via synchronous videoconference, and the costs of electronic devices and internet access were not considered. This study also did not assess other factors likely to affect cost savings, such as rural vs urban residences, race, education, or insurance type, all of which should be explored in future studies. Finally, further data are needed if long-term oncologic outcomes with telehealth visits are equivalent to those seen in person, which can change costs of treatment.

Conclusions

Patients with cancer spend a substantial amount of time and money traveling to receive care. Using a large data set, we found that cancer care delivery via telehealth was associated with time, travel, and cost savings for patients with cancer, which may reduce the financial toxicity of cancer care. Future studies should explore other cost savings, such as the savings to cancer caregivers and how these vary for rural and urban patients with cancer.

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Article Information

Accepted for Publication: November 18, 2022.

Published: January 10, 2023. doi:10.1001/jamanetworkopen.2022.50211

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2023 Patel KB et al. JAMA Network Open.

Corresponding Author: Krupal B. Patel, MD, MSc, Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612 (krupal.patel@moffitt.org).

Author Contributions: Dr Patel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Patel, Alishahi Tabriz, Gonzalez, Wang, Spiess.

Acquisition, analysis, or interpretation of data: Patel, Turner, Gonzalez, Oswald, Nguyen, Hong, Jim, Nichols, Wang, Robinson, Naso.

Drafting of the manuscript: Patel, Nichols.

Critical revision of the manuscript for important intellectual content: Patel, Turner, Alishahi Tabriz, Gonzalez, Oswald, Nguyen, Hong, Jim, Wang, Robinson, Naso, Spiess.

Statistical analysis: Patel, Wang, Naso.

Obtained funding: Patel.

Administrative, technical, or material support: Patel, Turner, Alishahi Tabriz, Gonzalez, Robinson, Naso.

Supervision: Patel, Gonzalez, Jim, Nichols.

Conflict of Interest Disclosures: Dr Gonzalez reported receiving personal fees from Sure Med Compliance and personal fees from Elly Health outside the submitted work. Dr Jim reported being a consultant for Janssen Scientific Affairs and Merck, and reported receiving grants from Kite Pharma outside the submitted work. Dr Spiess reported being the Vice Chair of the National Comprehensive Cancer Network Penile/Bladder Guidelines Panel, President of the Global Society of Rare GU Tumors, and a board member of the Societe of Internationale D’Urologie Journal outside the submitted work; none of these roles are compensated. No other disclosures were reported.

Data Sharing Statement: See Supplement 2.

Additional Contributions: The authors would like to acknowledge the members of Moffitt Cancer Center’s Planning and Market Data Analytics Department for their help with data curation and analysis, and April Manna, MS, for administrative assistance. Editorial assistance was provided by the Moffitt Cancer Center’s Office of Scientific Publishing by Gerard Hebert, MA, and Daley Drucker, BA. No compensation was given beyond their regular salaries. We would also like to thank donors to the COVID-19 Fund at Moffitt Cancer Center for their generous support, which helped to fund research to improve the quality and cost savings offered through Virtual Health.

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The post Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer appeared first on Dr. Miltie.

The experience of cancer — of getting a cancer diagnosis, surviving cancer, losing someone to cancer — has touched virtually every American family. 

This is personal for the President and First Lady, like it is for so many of you.

As Vice President, in 2016, Joe Biden led the Cancer Moonshot with the mission to accelerate the rate of progress against cancer. The cancer advocacy, patient, research and health care communities responded with tremendous energy and ingenuity.

Now, President Biden has reignited the Cancer Moonshot and set a new national goal: if we work together, we can cut the death rate from cancer by at least 50% over the next 25 years, and improve the experience of people  and their families living with and surviving cancer. 

We can make real progress toward ending cancer as we know it.

It will take all of us doing our part.  Join us.

We Need Your Help

Achieving the bold goals laid out by President Biden and First Lady Jill Biden will take all of us.  Progress will be informed by patients, caregivers, and families and made by all parts of the oncology community and beyond.  President Biden calls on the private sector, foundations, academic institutions, healthcare providers, and all Americans to join the mission of reducing the deadly impact of cancer and improving patient experiences in the diagnosis, treatment, and survival of cancer. We invite all Americans to share perspectives and ideas; — organizations, companies, and institutions to share actions they plan to take as part of this mission.

Share Your Ideas and Stories

Ending cancer as we know it will take all of us doing our part.

We know that the best ideas, the stories that will inspire change, and the actions that can help deliver on this bold mission come from across the United States and beyond. 

President Biden is calling, on the:

• Scientific community to bring its boldest thinking to this fight;
• Medical and public health community to improve their outreach to and support for underserved communities, to help patients and families have the best experience possible while living with and surviving cancer, and to improve patient outcomes;
• Private sector to step up — to develop and test new treatments, to share more data and knowledge, and to collaborate on tools that can benefit all Americans; and
• People living with cancer and survivors, their caregivers and families,  and those who have lost someone to keep sharing their perspectives and experiences and to keep pushing for progress.

The goals and priorities for the Cancer Moonshot must be informed by those with direct experience with cancer. 

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The internet, COVID-19 pandemic and increased access to smartphones and laptops has changed the way people shop, bank, travel and work. It also has changed how people manage their health care.

Telehealth, including telemedicine and virtual visits, uses digital information and communication technologies to access health care services remotely and manage your health care. It’s often thought of as remote communication or monitoring between a health care team and the patient or caregiver.

Asynchronous and synchronous communication

Some interactions are asynchronous, meaning communication that doesn’t happen at the same time. For example, a patient sends a message through an online portal and the health care team responds at a different time. Or a patient completing an online survey about symptoms to update the health care team.

Remote monitoring, which is asynchronous technology that collects and reports temperature, weight and other vital signs, allows the health care team to check a patient’s status without a visit to a health care facility. Any identified problems are usually addressed quickly.

In contrast to these examples are synchronous interactions, in which the patient and health care team communicate in real time. A telephone conversation is synchronous communication and an important part of a health care journey. Virtual visits use online technology to allow the patient and team to see and hear each other in real time. These synchronous communication telehealth options extend health care to meet patient needs.

Telehealth options are available for general health care, acute needs or specific conditions. Virtual visits became common because of the needs of the COVID-19 pandemic. Two years later, oncology professionals recommend telehealth interactions when appropriate for the patient or the caregiving team.

Telehealth and cancer care

For many people with cancer or malignant diagnosis, telehealth has become an important part of their care. It may be appropriate for medical oncology, hematology, consultations, second opinion consultations and surgical consultations.

Many patients use portal online messages throughout their cancer journeys to communicate medication side effects, changes in condition or send questions to the health care team. Other common telehealth options during cancer care are virtual visits and telephone conversations. These extend care and options for patients, regardless of geography. Occasionally, remote monitoring is part of cancer treatment plans as well.

Some appointments and treatments cannot be conducted virtually. The health care team recommends in-person or virtual visits based on the needs and treatment plan for each patient.

Telehealth benefits

There are multiple benefits of telehealth for all patients, but especially for people with a chronic or complex health condition, such as cancer, including:

• Greater access
  Telehealth can bring cancer experts to people who live in remote communities. It can provide people with choices to meet with specialists who don’t live where they do, especially when they are seeking a second opinion on a complex cancer diagnosis. Patients who don’t have good access to devices or internet may be able to participate in virtual appointments by using cancer center clinic resources and assistance.
• Reduced travel time and expense
  Cancer care requires many appointments, and patients often travel significant distances to receive the care they need. Some appointments, especially consultations or general checkups, can be completed virtually. This reduces travel time and expense for the patient and family. Not every appointment can be conducted using telehealth but saving travel expenses a few times can make a significant difference.
• Larger support network
  Most of the time, patients who receive care in Oncology attend visits with a family member or other support person. Virtual visits allow remote family members to participate in important conversations, ask questions and lend support, regardless if they live across the street or across the country.
• Improved energy
  Gearing up to travel to and from an appointment can be a challenge, especially if a person is experiencing severe fatigue due to cancer treatment. Participating in virtual visits can be less draining and preserves energy for recovery.
• Improved safety
  Hospitals and clinics are safe to visit and receive care. However, traveling to and from appointments does increase a person’s exposure to infectious diseases in the community, such as influenza and COVID-19. Mobility and falls are concerns for some people. Remaining at home to receive care can keep the person safe.

There are limitations to telehealth. Sometimes technology doesn’t work as well as designed. It’s important to have a plan with your health care team to call on the telephone if there is an issue connecting to a virtual visit.

Some people have no or limited internet access and may have to travel to a local clinic to participate in a virtual visit with specialized providers at other sites. Others don’t have or don’t feel confident using a mobile device or may need to have an exam done in person. Telehealth may not be appropriate for these patients. However, it’s an important tool to have that can extend options for care.

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Remote patient monitoring can help enhance chronic care management in many ways, including allowing clinicians to track their patients daily and adjust treatment plans in real time.

May 27, 2022 – Amid the rapid expansion of virtual care, remote patient monitoring (RPM) has emerged as a reliable tool for treating both acute and chronic conditions.

RPM involves leveraging connected digital tools to record personal health data in one location that a provider reviews at a different location, either in real time or later, according to the Department of Health and Human Services’ Health Resources and Services Administration.

RPM programs employ different devices, like weight scales, pulse oximeters, blood glucose meters, blood pressure monitors, and heart monitors. These enable providers to keep track of patient health metrics between clinic visits and adjust treatment plans as needed, making RPM a beneficial tool for long-term chronic disease management. Further, hospital-at-home programs have proved to be a viable alternative to in-hospital stays for patients with chronic diseases.

Here are some of the chronic conditions that could benefit from RPM services:

DIABETES

There is strong evidence showing that RPM can improve diabetes care, and as a result, providers are increasingly incorporating the care modality into their diabetes services.

A study published in 2019 showed that patients with more frequent and regular participation in remote monitoring had lower hemoglobin A1c levels — which measures average blood sugar — at the end of the program.

Even during the COVID-19 pandemic, RPM helped providers manage type 2 diabetes patients. A study conducted at St. Joseph’s/Candler health system in Savannah, Georgia, showed that an RPM platform managed by a pharmacist helped reduce A1c levels by 2.2 percent over a six-month period in 2020.

In addition to type 2 diabetes patients, RPM tools can be used to improve care for young children with type 1 diabetes. Stanford Children’s Health in Palo Alto, California, conducted a study that showed 53 percent of children provided with continuous glucose monitors reached the standard of care goal of having an A1c below 7 percent.

“There has been debate in the medical community about when is too early to start diabetes technology,” Priya Prahalad, MD, Stanford Children’s Health pediatric endocrinologist and member of the Maternal and Child Health Research Institute at Stanford Medicine, previously told mHealthIntelligence. “And I think what we are able to show is that starting diabetes technology early does not have any adverse effects on patients and families. It does not decrease their quality of life.”

Among providers, RPM strategies are increasingly being applied to diabetes care. In April, UBMD Pediatrics, a medical group in New York State, announced a collaboration with Cecelia Health to enhance care for children with type 1 diabetes by providing RPM.

Last year, the University of Mississippi Medical Center partnered with a federally qualified health center to increase access to diabetes care through RPM.

HYPERTENSION

Several studies have found that RPM can help maintain and decrease hypertension or high blood pressure (BP).

One published in 2018 showed that 81 percent of hypertension patients who enrolled in a home-based BP monitoring program achieved their BP goal in about seven weeks. Another study showed an RPM program that combined home BP monitoring with virtual nursing support helped maintain and even reduce BP during the pandemic.

Not only that but home-based BP measurements were found to be more reliable and accurate than those taken in clinics or kiosks.

Based on this clinical evidence, several providers have incorporated RPM into their hypertension treatment programs.

Last year, Northwestern Medicine piloted OMRON Healthcare’s VitalSight RPM service for its high-risk hypertensive patients. The service provides patients with the necessary devices to measure and share BP readings with their care team.  

And it’s not just the major health systems — smaller facilities with fewer resources are also turning to RPM to manage hypertension. In January, North Carolina-based federally qualified health center Robeson Health Care Corporation announced a partnership with HealthSnap that would enable it to offer RPM to more than 2,500 patients living with hypertension.

CANCER

Research showing that RPM can be used to enhance cancer treatments was available long before the pandemic.

In a study published in 2016, some patients receiving routine outpatient chemotherapy at Memorial Sloan Kettering Cancer Center were asked to report 12 common symptoms via tablet devices. Health-related quality of life improved for patients who reported their symptoms via the tablet than those who received usual care, which did not include remote self-reporting of symptoms. Further, patients receiving the intervention were less frequently admitted to the emergency room or hospitalized.

More recently, researchers at Huntsman Cancer Institute at the University of Utah found that the patients who participated in its adult oncology hospital-at-home program were 58 percent less likely to be admitted for an unplanned hospital stay than those not in the program.

Amid the recent disruptions in cancer care, RPM has helped ensure continued care access for cancer patients in their own homes, including those who contracted COVID-19.

A study published last September showed most COVID-19-positive cancer patients enrolled in an RPM program agreed that the program was worthwhile, enabled better management of their COVID-19 symptoms, and made them feel more connected to their care team.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems.

Studies show that RPM can be used to improve care for COPD patients, including one where researchers concluded that “remote monitoring of COPD patients holds promise for detection of exacerbation events.”

Another study published in 2021 revealed that RPM could help make COPD diagnoses and treatment more efficient.

In addition, research indicates that patients are ready to use a telemonitoring system for at-home pulmonary rehabilitation. The study published in 2018 shows that 98 percent of the participants agreed the system was easy to use and said they would be willing to use it throughout the pulmonary rehabilitation period.

As the initial COVID-19 surges slowed, providers and payers began adding COPD care to their home monitoring programs.

In 2021, West Tennessee Health modified its RPM platform to monitor patients with congestive heart failure and COPD, and Deaconess Health made a similar move.

Humana also launched a home healthcare service last year that included RPM. The payer announced plans to develop care pathways for members with various chronic conditions, including COPD.

As RPM becomes further integrated into care delivery, the physical boundaries of the healthcare system will shift, opening up possibilities for more comprehensive chronic care management.

The post 4 Chronic Care Use Cases for Remote Patient Monitoring appeared first on Dr. Miltie.