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Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic.

ABSTRACT: PURPOSE:Cancer patients have many medical and psychosocial needs, which may increase during the COVID-19 pandemic. We sought to (1) risk-stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between two risk stratification methods, and (3) perform a telephone-based needs assessment with intervention for high-risk patients. METHODS:Patients were risk-stratified using a general medical health composite score (HCS) and a cancer-specific risk (CSR) stratification based on disease and treatment characteristics. The correlation between HCS and CSR was measured using Spearman's correlation. A multi-disciplinary team developed a focused needs assessment script with recommended interventions for patients categorized as high-risk by either method. The number of patient needs identified and referrals for services made in the first month of outreach are reported. RESULTS:A total of 1697 patients were risk-stratified, with 17% high-risk using HCS and 22% high-risk using CSR. Correlation between HCS and CSR was modest (? = 0.41). During the first month of the pilot, 286 patients were called for outreach with 245 contacted (86%). Commonly identified needs were financial difficulties (17%), uncontrolled symptoms (15%), and interest in advance care planning (13%), resulting in referral for supportive services for 33% of patients. CONCLUSION:There is a high burden of unmet medical and psychosocial needs in hematology/oncology patients during the COVID-19 pandemic. A telephone-based outreach program results in the identification of and intervention for these needs; however, additional cancer-specific risk models are needed to improve targeting to high-risk patients.

SUBMITTER: Osterman CK

PROVIDER: S-EPMC7549726 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic.

Osterman Chelsea K CK Triglianos Tammy T Winzelberg Gary S GS Nichols Angela D AD Rodriguez-O'Donnell Julia J Bigelow Sharon M SM van Deventer Hendrik H Sanoff Hanna K HK Ray Emily M EM

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 20201012 3

<h4>Purpose</h4>Cancer patients have many medical and psychosocial needs, which may increase during the COVID-19 pandemic. We sought to (1) risk-stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between two risk stratification methods, and (3) perform a telephone-based needs assessment with intervention for high-risk patients.<h4>Methods</h4>Patients were risk-stratified ...[more]

PMID: 33047163

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Project description:In response to the COVID-19 social distancing guidelines, residency and fellowship programs transitioned to virtual instruction to deliver didactics and continue with medical education. The efficacy of such a fully online learning environment, however, remains unknown. To investigate its impact on medical education, this study surveyed hematology/oncology fellows at The University of Texas MD Anderson Cancer Center on their attitudes regarding the online-based lecture program. Fellows were emailed a 19-question survey with questions on demographics, ease of technical access to the online platform, level of comfort with participation, knowledge acquisition, wellness, and COVID-19-specific coverage. A free-text question soliciting ways to improve upon online learning was also included. The response rate was 71% (30/42). Most respondents reported easy/very easy accessibility to the online environment. Seventy-seven percent of the participants did not experience a technical issue. Seventy percent felt comfortable/very comfortable with participating in the conference. Thirty-seven percent felt comfortable/very comfortable with actively offering an answer to questions during the interactive board review session. Eighty-seven percent would have been more willing to offer an answer during the board review session if an anonymous poll format was utilized. Sixty-three percent felt they learned the same amount as they typically do during an in-person session. Thirty-three percent reported they were less focused as compared with an in-person session. One hundred percent of the participants had their questions answered, either at all times (87%) or sometimes (13%). Sixty percent experienced a change in social interactions as compared with an in-person session. Fifty-four percent reported that it was easy/very to balance online attendance despite personal/family commitments. One hundred percent appreciated the flexibility of the online learning environment. Ninety percent felt safer at home attending these lectures compared with receiving these lectures in-person during the COVID-19 pandemic. Overall, most fellows felt comfortable with the transition to a fully online learning environment. Strategies to encourage active participation, enhance social interaction, and provide additional flexibility are still needed.

Project description:BackgroundSince the beginning of the coronavirus disease 2019 (COVID-19) outbreak, the Critical Care Outreach Team (CCOT) remained operational to provide critical care support to acutely ill and deteriorating patients on the wards. We aimed to evaluate the demand and efficacy of the critical care outreach service during the COVID-19 pandemic.MethodWe prospectively evaluated all patients referred to critical care outreach enrolled during a twelve-month period. We reported the cumulative number of activities and interventions and baseline characteristics, acuity level and patients' clinical outcome. The rate of ICU admissions, activity plan, patients' acuity and mortality are compared to historical data pre-pandemic.ResultsAmongst 4849 patients referred, 3913 had a clinical review and of those 895 were COVID-19 positive. Non-invasive ventilation was mostly delivered to COVID-19 patients (COVID-19 +VE: 853/895, 95% vs. COVID-19 -VE: 119/3018, 4%) alongside awake prone positioning (COVID-19 +VE: 232/895, 26% vs. COVID-19 -VE: 0/3018, 0%). Compared to pre-pandemic, the cumulative number of patients assessed increased (observed: 3913 vs. historical: 3615; p = 0.204), patients meeting Level 2 acuity were higher (observed: 51% vs. historical: 21%; p = 0.003), but ICU admission rate did not increase significantly (observed: 12% vs. historical: 9%; p = 0.065), and greater mortality rate (observed: 14% vs. historical: 8%; p = 0.046) was observed.ConclusionCritical care outreach bridges the gap between the intensive care unit and general wards and supports the concept of 'critical care without walls' acting as a valuable resource in optimizing and triaging acutely unwell patients and potentially averting critical care admissions.Relevance to clinical practiceThe COVID-19 pandemic has generated an unprecedented surge of deteriorating and critically ill patients with has caused severe and sustained pressures on intensive care units (ICUs) and general wards. Acutely ill patients can deteriorate quickly, and early recognition is vital to commence critical intervention on the wards or transfer timely to ICU. The Critical Care Outreach Team can help staff and optimize acutely ill and deteriorating patients by providing timely critical care interventions at the patient bedside.

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Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic.

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Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic.

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