Table 2 Key findings from combined CAPRI design studies
From: How to Design a Remote Patient Monitoring System? A French Case Study
NĀ° | Studies | Sample | Main results | Principal findings for design intervention and implementation | Principal findings for evaluation |
|---|---|---|---|---|---|
1 | Literature review | 3 literature review identified | Effective intervention based on literature reviews: - Patient information - Decision āmaking aids for patients - Audiotaped consultation - Follow-up by nurses - Follow-up by GPs - Case management - One-stop clinic - Shared-care programme | Selection of components from the CCM | Combination of randomised controlled trial (RCT) and process evaluation |
2 | IT usages in cancer care coordination | 46 articles analysed in realistic literature reviews | Identification of six uses of TIC: document management, dissemination of information and pooling of patient data, communication between stakeholders, aid in clinical decision-making, patient education and level of independence, personalisation and coordination of care pathway | - Definition of the functional basis provided by the technological tools used in the intervention programme - Implementation recommendation: promote the sharing of information and system integration, rigorously plan the design of the intervention, improve project management, work on tool ergonomics, plan the secure data strategy | Need to devise a robust evaluation strategy to assess the quality of life, satisfaction, organisational and economic impacts as well as the clinical outcome. |
3 | Patient use of IT | nĀ =ā1371 questionnaires (participation levelā=ā85%) Median age of patients: 53.4āyears, 70% were females | Access and use: 93% had home access to the Internet, 71% used a mobile phone every day and most patients reported never using tablets Willingness to use IT for their health: The most useful features: - Having access to electronic records, completion of a self-test to assess health status, communicating with physician via email, booking appointments and obtaining information about their disease - The least useful features: chatting with peer patients, communication via video Perceived ease of use: 84% confirmed that they were able to use a computer, tablet or smartphone | - Study provided cancer patients with an opportunity to use IT for health purposes, no major obstacles identified but the effects of age and socioeconomic status have to be addressed. - No need to equip the patient with any additional material (e.g. digital tablet). - Selection of priority functions to be integrated in the tool (data collection system, secure messaging system, information source provided, etc.). - Data security requirements - Key contacts | To be considered in process evaluation: Acceptance of the IT tool, patient profile with regard to IT, frequency of use and changes in use over time |
4 | Home care coordination activities and skills | Qualitative phase: 17 interviews with patients and 2 focus groups with NNs Quantitative phase: 543 phone calls received via COC platform | Five categories of NNs-related activities defined as: 1. Patient monitoring (e.g.: reporting side effects) 2. Navigation assistance (clinical pathways) 3. Managing technical problems (difficulties in drug or medical device delivery or equipment malfunction) 4. Explaining care protocols (e.g. clarification about the application of a drug prescription) 5. Collecting and transmitting patient data Although a significant proportion of the NNsā activities involve patient monitoring (29%), most of the requirements (71%) relate to organisational issues. | - Definition of the NNs profile and development of the job description (role of case manager with clinical skills, knowledge of outpatient care and the healthcare system) - Need to develop tools for nurses to assist in the management of patient follow-up (clinical decision support, protocol) | To be considered in process evaluation: - organisational change triggered - Characteristics of NNs activities |
5 | Care coordination needs | 59 individuals met, 45 interviews conducted ā19 Patients ā11 Community professionals(GP, Private nurses, Dietician, Pharmacist) - 29 Gustave Roussy Professionals | Potential benefits of the digital tool - Standardisation of follow-up informationProvision of practical information on a daily basis - Functions: long-distance consultation, document dispatch (results, evaluation, photos), monitoring of vital parameters, organisation of appointments, storage and permanent access to information, list of personal contacts Potential benefits of NNs - To answer telephone calls and receive alerts - To have explanatory consultations in addition to the normal reporting system (diagnosis, relapse, discontinuation of treatments, etc.) - To support patients along the pathway - To send information to various professionals involved in the patientās treatment pathway (hospital and community) and to guarantee the link between patient, treating physician and referral oncologist NNs location: - Community professionals may have a lack of information and training in oncology, they have difficulties in having oncologist expertise | Warnings relating to the digital tool: - Does not replace direct or telephone contact - The information collected is not sufficient to trigger a decision and action - Avoids the risk of intrusion in the patientās home Warnings regarding the role of the NNs ā what the NN must not do: - Manage appointments, guarantee regulations and refer to emergency unit, responding to medical alerts and take decisions Conditions for a successful outcome: - Have a baseline (with clinical decision support tool) which is validated by all the committees, with warning thresholds and procedures to follow NNsā profile: - Case manager role with clinical competencies, knowledge of the outpatient and care system - Ability to interact with the Hospital Information System NNs location: - Hospital: to have an easy access to the oncologistās expertise | Population selection: patients treated with oral anticancer drugs RCT: - Choice of primary evaluation criterion/endpoint: Efficacy hypothesis: thanks to faster management of treatment-related side effects, patients participating in the CAPRI intervention programme will demonstrate a significant increase in Relative Dose Intensity (RDI) - Choice of secondary criteria: patient compliance, quality of life, patient experience, tumour response, Progression Free Survival, Overall Survival, toxic side effects and economic evaluation (medical and non-medical costs) Process evaluation: Study of changes in organisational transformations and, in particular, the impact of the intervention programme on the oncologistsā workload |
6 | Patient information needs | 19 interviews with patients | - Patients were looking for treatment documentation on treatments but three types of non-medical information were also identified: a) Information on the care pathway, hospital and on health care system in general (e.g. administrative rules, departmental structure); b) Information on supportive care (e.g. services, activities) and how to contact professionals internally (within the hospital) and externally (e.g. dietician, psychologist); c) Information on living with cancer and its impact on daily activities. - Patient dissatisfaction is linked not only to the lack of medical information but also reflects other needs, which are not taken into account (e.g. expanding on information to make it understandable and useful). | - Information must be considered using an integrated and holistic approach to facilitate the patient navigation process and improve health-related literacy - Training of healthcare professionals is crucial, but this is not enough. The introduction of other, non-carer professionals is necessary to address a wide range of patient-related needs in a more effective and cost-efficient manner. | Assessment criteria used in the longitudinal analysis: Acceptance by patients |
7 | Emergency Department (ED) referrals | Electronic medical record review: 500 referrals related to 423 patients | - Referrals were appropriate in 61% of cases - Referrals were deemed potentially avoidable in 33.4% of cases, potentially avoidable in 14.4% and unavoidable in 52% of cases Opportunities to avoid referrals after index hospitalisation involved this hospital stay or discharge process in 66 cases (28%), the follow-up period in 59 cases (25%), or both in 66 cases (28%). Causes of potentially avoidable referrals may be linked to three main problems: - A lack of effective care during follow-up (lack of medical expertise, either on the part of the oncologist regarding chronic or intercurrent conditions or on the part of the GP about cancer) - Care coordination (lack of information for outpatient providers on referrals, and outpatient referrals omitted) - Patient management during the index hospitalisation (premature discharge or inadequate assessment of post- discharge risk) | - Lack of information from inpatient to outpatient providers but also vice-versa - Most inappropriate referrals needed consultations and not in a hospital setting - Merits of the GP to be in contact with the oncologist to improve the relevance of referrals - Need for tools to facilitate communication, legal framework development, financial incentives, training in shared medical management and patient education | Criteria regarding readmission and ED visits were added to protocol evaluation |
8 | Clinical monitoring needs | 22 interviews with oncologists, NNs, and support packages | Drafting of clinical decision support tool in conjunction with a follow-up protocol through joint work between the NNs and the various Gustave Roussy Medical Discipline Leads regarding the information provided by analysing the medical and paramedical literature and obtaining expert opinions. | - Modelling of the follow-up process (initial NNs consultation, frequency of follow-up, items to be assessed, pooling of information) - Devising NNs follow-up tools (clinical decision support) - 80 validated clinical decision support tool | Design of NNs activities for improving evaluation criteria |