By Bobby Daly, Abigail Baldwin-Medsker & Wendy Perchick
• Until the 1990s, patients with cancer requiring chemotherapy typically had to be admitted to the hospital to receive treatment. This inpatient care was stressful for patients, and expensive. Since then, thanks to improvements in chemotherapy administration and symptom management, most treatment has moved from the inpatient setting to outpatient clinics, which have proved more patient-centered and able to provide high-quality care at lower cost.
The InSight Care program seeks to identify high-risk patients and provide digitally enabled, proactive, coordinated care before they need hospitalization. The digital connections allow us to keep patients in sight beyond our walls, and lower barriers for patient communication with team members. To this end, the program leverages three interlocking elements:
• A novel risk prediction mode.InSight’s predictive analytics framework was built from 10,000 observations of patients starting chemotherapy, and has been refined to predict risk of acute hospitalization based on 270 patient characteristics spanning sociodemographics, the nature of the malignancy and treatment, lab results, medical and social history, medications and prior emergency department visits and hospitalizations.
• Digital monitoring. Patients enrolled in the program receive a daily symptom survey through a patient portal based on our analysis of common symptoms leading to acute-care visits.
• Digital team-based care. A dedicated, centralized cohort-management team, consisting of registered nurses and nurse practitioners, acts as an extension of the primary oncology team with whom they collaborate. If a patient needs to be physically seen, the team can determine the right setting for evaluation.
A more proactive, connected cancer-care system will ultimately benefit patients, providers and society at large as cancer-care quality and patient experience improve and costs fall. Our Insight Care program is a promising initiative on that path which we hope other providers can learn from. Everyone wins when patients with cancer can avoid the emergency room and do better as a result.
Bobby Daly and Abigail Baldwin-Medsker are clinical leads for the InSight Care Program at Memorial Sloan Kettering Cancer Center. Wendy Perchick is a senior vice president at Memorial Sloan Kettering Cancer Center.