Patient navigation plus hospital at home to improve COVID-19 outcomes for cancer patients.

Authors

Brittany Ragon

Brittany K. Ragon

Levine Cancer Institute, Charlotte, NC

Brittany K. Ragon , Ashley Love Sumrall , Kris Blackley , Ify Osunkwo , Tamara Kay Moyo , Laura Kabrich , Kelly Leonard , Ben Masten , Beth York , Stephanie Murphy , Brian Kersten , Thomas Batchelor , Carly Rivet , Armida Parala-Metz , Zainab Shahid , Seungjean Chai , Laura W. Musselwhite , Declan Walsh

Organizations

Levine Cancer Institute, Charlotte, NC, Atrium Health, Charlotte, NC

Research Funding

No funding received
None

Background: Reports suggested cancer patients were at greater risk for increased morbidity and mortality from COVID-19. A process to mitigate these risks was established at Levine Cancer Institute (LCI) in partnership with Atrium Health’s (AH) Hospital at Home (HAH) initiative. This virtual health navigation process employed expertise from the departments of Hematologic Oncology and Blood Disorders, Oncology, and Supportive Oncology, including a specialized nurse navigation team, to rapidly identify COVID-19 positive LCI patients, monitor them under physician supervision, and escalate care as needed with AH HAH program. Methods: AH Information Services created an automated list of LCI COVID-19 positive patients with a daily database. Each patient was reviewed by a nurse navigator. Review included hematologic or oncologic diagnosis, outpatient or inpatient status, and any COVID-19 symptoms. Once a malignant diagnosis was confirmed, a diagnosis-specific navigator contacted and screened the patient with a COVID assessment tool. Documentation was forwarded to the primary oncologist/hematologist. The tool scored patients for surveillance and treatment needs. A score of 0-2 prompted phone assessment every 48-72 hours, and score of 3-5 required every 24-48 hour calls with physician involvement when appropriate. If score of ≥6, care was escalated to LCI nurse/physician for admission to AH acute care HAH or conventional inpatient admission. Results: From inception on 3/20/2020 to data review date of 12/2/2020, 974 LCI patients were identified as COVID-19 positive and reviewed for nurse navigation (Table). Of the 974, 488 were navigated. Given limited resources, patients with benign conditions were not assigned a navigator, though a similar process was created for sickle cell disease. Of the 974, 75 are now deceased. Only 25 are deceased among the 488 navigated. Conclusions: The COVID-19 pandemic presented unprecedented circumstances to our patients and their clinicians. LCI expeditiously put policies and procedures in place to mitigate the intersection of COVID-19 and cancer. The multidisciplinary response strategy liaising between AH HAH and LCI followed, assessed, and assisted LCI COVID-19 positive patients. With our embedded nurse navigation team’s specialized attention along with enhanced physician oversight and close collaboration with AH HAH, opportunities for care escalation or adjustments in cancer-focused care were promptly identified. Analysis is ongoing to elucidate the lower mortality rate observed among navigated patients.

COVID-19 positive patients defined by LCI criteria from 3/20/20-12/2/20, N=974.

Characteristic
N (%)
Diagnosis
 Hematologic Malignancy
143 (15)
 Solid Malignancy
561 (57)
 Hematologic and Solid Malignancy
6 (1)
 No Malignancy Identified
264 (27)
 Navigated Patients
488 (50)
Deceased Patients

 Navigated
25 (3)
 Not Navigated
50 (5)

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Care Delivery and Regulatory Policy

Track

Care Delivery and Quality Care

Sub Track

Care Delivery

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 1524)

DOI

10.1200/JCO.2021.39.15_suppl.1524

Abstract #

1524

Poster Bd #

Online Only

Abstract Disclosures

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