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Patients and healthcare providers at Princess Margaret Cancer Center rated virtual care during COVID-19 as being very satisfactory overall for quality of care and convenience, while saving patients millions of dollars.
Research by Princess Margaret, Radiation Oncologist Dr Alejandro Berlin, has shown that virtual care can be implemented quickly and safely in a highly specialized, high-volume cancer center. Eighty (80) percent of patients reported being very satisfied or satisfied with it, citing convenience as the main factor, with 72 percent of doctors reporting similar satisfaction with it.
In addition, 64 percent of health care providers and 85 percent of patients indicated that the quality of care was comparable or better than the in-person model of care. Sixty-six percent (66%) of respondents from both groups – patients and physicians – were very likely or likely to recommend virtual care for future appointments.
The overall cost savings for 22,085 patients studied during the research study period between March 23, 2020 and May 22, 2020 was over $ 3 million (CAD 3,085,274.00) – potentially $ 18 million for one year.
The results of the study are published in JAMA Oncology, January 7, 2021.
“The surprising result of implementing virtual care almost overnight has been the impressive benefits for our patients and clinicians,” says Dr Keith Stewart, Director of the Princess Margaret Cancer Center, Vice President, Cancer, University Health Network and one of the study authors
“With these results, a new standard emerges that includes virtual care as a feasible and important part of care for many patients. They will help guide the transformation of telemedicine in the post COVID-19 era, firmly establishing virtual care as a standard option that we can provide suitable patients. “
Virtual care was developed and launched at Princess Margaret 12 days after the declaration of the COVID-19 pandemic on March 11, 2020.
This was done to protect patients from preventable exposure and to minimize the impact of infection control measures and concerns about the availability of personal protective equipment for patients and staff.
Four days after the launch of the digital solution to support virtual care, on March 23, 2020, more than 50% of outpatient visits were switched to virtual care, consisting of video or phone calls.
A month after the March 23 start date, outpatient clinic volumes (in-person and virtually) were restored to pre-COVID-19 levels – approximately 3,900 clinic visits per week.
In total, from March 23, 2020 to May 22, 2020, 22,085 virtual visits by phone or video took place, which represents an average of 68% of daily visits to the clinic.
Importantly, chemotherapy and radiation therapy site visits, as well as safety and timeliness parameters for cancer care remained stable throughout the study, comparable to the pre-COVID-19 period.
“The move to virtual care has ensured that patients requiring in-person visits, such as those receiving chemotherapy and radiation treatments, can continue, while reducing traffic and facilitating physical distance on the scene.” says Dr. Berlin.
“This has allowed our high-volume center to care for all of our patients during a troubling and uncertain time – without compromising the safety or quality of care.”
Institutional and provincial cancer care quality standards – such as safety incidents and referrals seen within 14 days – were followed throughout the study and beyond, and no change was observed.
“Virtual care has become a safety net for patients,” says Dr. Berlin, who is also an assistant professor in the Department of Radiation Oncology at the University of Toronto. “It was reassuring for patients during the uncertainty of COVID-19. Their care team was always there for them, but in a different way.
“Going forward, we aim to examine what criteria – in addition to clinical criteria – make this a good, if not preferred, option for some patients.”
Dr Berlin describes several factors that have contributed to the success of the project, including:
- A sense of urgency to achieve a well-defined and clearly communicated goal (a shift from more than 50% of visits to virtual care) which has a significant impact for patients and clinicians,
- An agile design and implementation approach, based on existing software, and continuous feedback that has been folded into new iterations,
- Involvement of many stakeholders, including front line staff, to map “weak points” and workflows,
- A tight-knit multidisciplinary team – from technical design to patient and family input – that has come together seamlessly to meet this unprecedented challenge.
“We went big and bold because of the needs of the moment,” says Dr. Berlin.
“It was a huge effort on the part of everyone at Princess Margaret,” he says. “Behind every patient call or video was a clinician committed to ensuring continuity of care for our patients. Working behind the scenes of each meeting, there was an entire team with varying expertise.
“It was heartwarming for our patients. What emerges from our surveys is that patients felt supported, cared for and comforted as uncertainty continues to be the norm.
“Patients could focus on what was most important to them – their health.”
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This work was supported by funds from the Princess Margaret Cancer Foundation.
About the Princess Margaret Cancer Center
The Princess Margaret Cancer Center has established an international reputation as a world leader in the fight against cancer and the provision of personalized cancer drugs. The Princess Margaret, one of the top five international cancer research centers, is a member of the University Health Network, which also includes Toronto General Hospital, Toronto Western Hospital, Toronto Rehabilitation Institute, and the Michener Institute for Education of the ‘UHN. All are research hospitals affiliated with the University of Toronto. For more information: http: // www.
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