Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19

Abstract

IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality. OBJECTIVE To examine the outcomes of a cancer center-wide virtual care program in response to the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020. MAIN OUTCOMES AND MEASURES Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients. RESULTS The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD$ 202 537, and displacement-related cost savings to patients totaled CAD$ 3 155 946. CONCLUSIONS AND RELEVANCE These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era.

The Utilization and Benefits of Telehealth Services by Health Care Professionals Managing Breast Cancer Patients during the COVID-19 Pandemic

“…There is documentation of the implementation of a virtual care program at a highvolume cancer center that was feasible, maintained care quality and outpatient caseloads and had a high satisfaction among patients and physicians [75]. Loree and colleagues carried out an international Internet-based cross-sectional survey of 381 participants between April and June 2020 that evaluated patients' perspective and satisfaction with virtual appointment.…”

Impact of telemedicine adoption on accessibility and time to treatment in patients with thoracic malignancies during the COVID-19 pandemic

“…Limited data exist, however, on the direct impact of telemedicine on key quality of care metrics [ 14 ]. Preliminary studies during the pandemic have demonstrated that telemedicine utilization in the context of oncology practice can be rapidly adopted [ 15 ], though patient and provider perspectives on its utility vary [ 16 – 19 ]. Historically, telemedicine in oncology practice has focused on delivery of care to underserved rural areas [ 20 – 22 ], augmentation of global oncology efforts [ 23 , 24 ], provision of palliative care [ 25 ], remote monitoring of symptoms and mental health [ 26 ], and facilitation of multidisciplinary coordination with radiology and pathology teams [ 27 ].…”

A Cross-Sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults

“…Virtual healthcare has many benefits, including increasing safety for healthcare providers and patients by allowing for connectivity from a distance and increasing the accessibility for those who struggle to attend in-person appointments due to location or time constraints [33]. While the concept of virtual care is not new in oncology, the widespread delivery of virtual care increased significantly during pandemic to protect patients from COVID-19 infection [34]. Although most participants in our study wanted to include some form of video calls or telehealth into their cancer care, this was not a desirable option for all.…”