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Observational Study
. 2021 Apr 1;7(4):597-602.
doi: 10.1001/jamaoncol.2020.6982.

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

Alejandro Berlin  1   2   3   4 , Mike Lovas  1   5 , Tran Truong  2   3 , Sheena Melwani  1 , Justin Liu  3 , Zhihui Amy Liu  6   7 , Adam Badzynski  5 , Mary Beth Carpenter  8 , Carl Virtanen  8 , Lyndon Morley  6 , Onil Bhattacharyya  9 , Marnie Escaf  6 , Lesley Moody  6 , Avi Goldfarb  10 , Luke Brzozowski  2   3 , Joseph Cafazzo  3   5   11 , Melvin L K Chua  12   13   14 , A Keith Stewart  6   15 , Monika K Krzyzanowska  6   16
Affiliations
Observational Study

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

Alejandro Berlin et al. JAMA Oncol. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Melwani reported receiving funding from the Princess Margaret Cancer Foundation at University Health Network. Dr Goldfarb reported receiving personal fees from Boehringer Ingelheim, McKesson, Creative Destruction Lab, and the Neighbourhood Pharmacy Association of Canada outside the submitted work; receiving grants from the Sloan Foundation, the Social Sciences and Humanities Research Council of Canada, the National Science Foundation, Google, WPP, the Net Institute, Plurimus Corporation, and the Social Science Research Council; running a consulting company, Goldfarb Analytics Corporation, that advises organizations on digital and artificial intelligence strategies; receiving payment for lectures from Amazon, Bloomberg, BMC, Boehringer Ingelheim, eBay, Facebook, Google, the Hospital for Sick Children, Indigo, INTACT, McKesson, Microsoft, Netflix, Neoway, the Neighbourhood Pharmacy Association of Canada, Pinterest, RBC, ScotiaBank, Sisense, and Zetta Venture Partners; serving as the chief data scientist at the Creative Destruction Lab; and holding shares in many technology and health care companies. Dr Krzyzanowska reported receiving grants and personal fees from Eisai, grants from Exelixis and Ipsen, and personal fees from Bayer outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Timeline of the Virtual Care Initiative and Number of Ambulatory Visits Over Time
Ambulatory clinics volumes from February 18 to May 22, 2020, were stratified by type of appointment (in-person and virtual care [telephone or video]) for every business day of the corresponding week. Dates of COVID-19 declaration of pandemic by the World Health Organization (WHO) and deployment of the Virtual Care Management System (VCMS) are highlighted in blue.
Figure 2.
Figure 2.. Patient and Practitioner Satisfaction Survey Individual Responses
VC indicates virtual care.
See this image and copyright information in PMC

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