EVALUATION OF THE IMPLEMENTATION OF A NURSE CASE-MANAGER FOR THE DIAGNOSIS AND FOLLOW UP OF PATIENTS WITH SYMPTOMATIC MULTIPLE MYELOMA
(Abstract release date: 05/19/16)
EHA Library. Abella E. 06/09/16; 134995; PB2095
Dr. Eugenia Abella
Contributions
Contributions
Abstract
Abstract: PB2095
Type: Publication Only
Background
An early diagnosis and prompt treatment of patients with symptomatic multiple myeloma (SMM) is essential. Hence, the reduction in the timing of diagnostic tests is a key element that allows to initiate early treatment and to avoid secondary complications. The nurse case-manager (NCM) has a crucial role reducing the time needed for the completion of tests and results as well as in the optimization of visits in order to start therapy as soon as possible. In addition, the NCM may improve the follow-up of patients by reducing admissions and random visits, thus potentially decreasing costs.
Aims
To assess the intervention of the NCM in relation to: 1) the time needed to establish the diagnosis and start treatment and 2) the follow-up process.
Methods
From September 2014 to January 2016 a prospective, single center study in patients with suspected SMM (interventional group; IG) was started. Results were compared to a control group (CG) of patients diagnosed of SMM in the two years previous to the study. Primary end-points were: 1. Time from referral to first visit in the Hematology Dept., 2. Time from referral to completion of diagnostic tests, and 3. Time from referral to initiation of treatment. Secondary objective was to assess hospital admission incidence during the first year of follow-up in both groups. The effect of the NCM in time to event variables was investigated using a multiple linear regression (MLR), using the corresponding time variable as the dependent variable (Log10 transformed due to left skewed distributions) and admission at diagnostic period as a confounder. Fisher exact test was used for assessing incidence ratios. In IG, a 11-item patient satisfaction questionnaire (PSQ) was obtained and a log of phone calls (PC) was recorded. This log collects all contacts to the NCM made by IG patients. Bilateral p value of 0.05 was considered statistically significant.
Results
During this period, 22 patients were studied in the IG and compared to a CG of 37 patients. Table 1 shows the results of the effect of the NCM in the three main end-points.
*)5% trimmed mean c) p value of CM effect in MLR.The median value of PSQ was of 8,5/10, highlighting a significant patient satisfaction.A reduction in the incidence of admissions was observed (odds ratio: 1.20 p<0.05).During the study, 262 PC were collected and divided according to the discussed topic. 48.2% of PC were due to symptoms control: 85,7% were resolved by NCM or Physician and 14,3% were attended at the hospital. 26.7% of PC were related to treatment information: 86,6% were resolved by NCM or Physician and only 13.3% needed to attend the site. Finally, 25.1% of PC were related to schedule information and, of note, 98.4% were resolved during the call.
Conclusion
The incorporation of a NCM for the diagnostic and follow up of patients with SMM has allowed to reduce time from referral to visit, completion of tests and initiation therapy in the IG when compared with CG. Data collected during follow-up suggests that NCM involvement may lead to a decrease in hospital costs, with a significant patient perceived satisfaction. Further observation is warranted to confirm our preliminary findings.
Session topic: E-poster
Keyword(s): Multiple myeloma, Quality control
Type: Publication Only
Background
An early diagnosis and prompt treatment of patients with symptomatic multiple myeloma (SMM) is essential. Hence, the reduction in the timing of diagnostic tests is a key element that allows to initiate early treatment and to avoid secondary complications. The nurse case-manager (NCM) has a crucial role reducing the time needed for the completion of tests and results as well as in the optimization of visits in order to start therapy as soon as possible. In addition, the NCM may improve the follow-up of patients by reducing admissions and random visits, thus potentially decreasing costs.
Aims
To assess the intervention of the NCM in relation to: 1) the time needed to establish the diagnosis and start treatment and 2) the follow-up process.
Methods
From September 2014 to January 2016 a prospective, single center study in patients with suspected SMM (interventional group; IG) was started. Results were compared to a control group (CG) of patients diagnosed of SMM in the two years previous to the study. Primary end-points were: 1. Time from referral to first visit in the Hematology Dept., 2. Time from referral to completion of diagnostic tests, and 3. Time from referral to initiation of treatment. Secondary objective was to assess hospital admission incidence during the first year of follow-up in both groups. The effect of the NCM in time to event variables was investigated using a multiple linear regression (MLR), using the corresponding time variable as the dependent variable (Log10 transformed due to left skewed distributions) and admission at diagnostic period as a confounder. Fisher exact test was used for assessing incidence ratios. In IG, a 11-item patient satisfaction questionnaire (PSQ) was obtained and a log of phone calls (PC) was recorded. This log collects all contacts to the NCM made by IG patients. Bilateral p value of 0.05 was considered statistically significant.
Results
During this period, 22 patients were studied in the IG and compared to a CG of 37 patients. Table 1 shows the results of the effect of the NCM in the three main end-points.
| control* | intervention* | p valuec | |
| Time referral – first visit (days) | 16,6 | 7,6 | 0,022 |
| Time first visit – completion of last test (days) | 38,2 | 16,3 | 0,037 |
| Time completion of last test-initiation of treatment (days) | 45,0 | 24,4 | 0,044 |
Conclusion
The incorporation of a NCM for the diagnostic and follow up of patients with SMM has allowed to reduce time from referral to visit, completion of tests and initiation therapy in the IG when compared with CG. Data collected during follow-up suggests that NCM involvement may lead to a decrease in hospital costs, with a significant patient perceived satisfaction. Further observation is warranted to confirm our preliminary findings.
Session topic: E-poster
Keyword(s): Multiple myeloma, Quality control
Abstract: PB2095
Type: Publication Only
Background
An early diagnosis and prompt treatment of patients with symptomatic multiple myeloma (SMM) is essential. Hence, the reduction in the timing of diagnostic tests is a key element that allows to initiate early treatment and to avoid secondary complications. The nurse case-manager (NCM) has a crucial role reducing the time needed for the completion of tests and results as well as in the optimization of visits in order to start therapy as soon as possible. In addition, the NCM may improve the follow-up of patients by reducing admissions and random visits, thus potentially decreasing costs.
Aims
To assess the intervention of the NCM in relation to: 1) the time needed to establish the diagnosis and start treatment and 2) the follow-up process.
Methods
From September 2014 to January 2016 a prospective, single center study in patients with suspected SMM (interventional group; IG) was started. Results were compared to a control group (CG) of patients diagnosed of SMM in the two years previous to the study. Primary end-points were: 1. Time from referral to first visit in the Hematology Dept., 2. Time from referral to completion of diagnostic tests, and 3. Time from referral to initiation of treatment. Secondary objective was to assess hospital admission incidence during the first year of follow-up in both groups. The effect of the NCM in time to event variables was investigated using a multiple linear regression (MLR), using the corresponding time variable as the dependent variable (Log10 transformed due to left skewed distributions) and admission at diagnostic period as a confounder. Fisher exact test was used for assessing incidence ratios. In IG, a 11-item patient satisfaction questionnaire (PSQ) was obtained and a log of phone calls (PC) was recorded. This log collects all contacts to the NCM made by IG patients. Bilateral p value of 0.05 was considered statistically significant.
Results
During this period, 22 patients were studied in the IG and compared to a CG of 37 patients. Table 1 shows the results of the effect of the NCM in the three main end-points.
*)5% trimmed mean c) p value of CM effect in MLR.The median value of PSQ was of 8,5/10, highlighting a significant patient satisfaction.A reduction in the incidence of admissions was observed (odds ratio: 1.20 p<0.05).During the study, 262 PC were collected and divided according to the discussed topic. 48.2% of PC were due to symptoms control: 85,7% were resolved by NCM or Physician and 14,3% were attended at the hospital. 26.7% of PC were related to treatment information: 86,6% were resolved by NCM or Physician and only 13.3% needed to attend the site. Finally, 25.1% of PC were related to schedule information and, of note, 98.4% were resolved during the call.
Conclusion
The incorporation of a NCM for the diagnostic and follow up of patients with SMM has allowed to reduce time from referral to visit, completion of tests and initiation therapy in the IG when compared with CG. Data collected during follow-up suggests that NCM involvement may lead to a decrease in hospital costs, with a significant patient perceived satisfaction. Further observation is warranted to confirm our preliminary findings.
Session topic: E-poster
Keyword(s): Multiple myeloma, Quality control
Type: Publication Only
Background
An early diagnosis and prompt treatment of patients with symptomatic multiple myeloma (SMM) is essential. Hence, the reduction in the timing of diagnostic tests is a key element that allows to initiate early treatment and to avoid secondary complications. The nurse case-manager (NCM) has a crucial role reducing the time needed for the completion of tests and results as well as in the optimization of visits in order to start therapy as soon as possible. In addition, the NCM may improve the follow-up of patients by reducing admissions and random visits, thus potentially decreasing costs.
Aims
To assess the intervention of the NCM in relation to: 1) the time needed to establish the diagnosis and start treatment and 2) the follow-up process.
Methods
From September 2014 to January 2016 a prospective, single center study in patients with suspected SMM (interventional group; IG) was started. Results were compared to a control group (CG) of patients diagnosed of SMM in the two years previous to the study. Primary end-points were: 1. Time from referral to first visit in the Hematology Dept., 2. Time from referral to completion of diagnostic tests, and 3. Time from referral to initiation of treatment. Secondary objective was to assess hospital admission incidence during the first year of follow-up in both groups. The effect of the NCM in time to event variables was investigated using a multiple linear regression (MLR), using the corresponding time variable as the dependent variable (Log10 transformed due to left skewed distributions) and admission at diagnostic period as a confounder. Fisher exact test was used for assessing incidence ratios. In IG, a 11-item patient satisfaction questionnaire (PSQ) was obtained and a log of phone calls (PC) was recorded. This log collects all contacts to the NCM made by IG patients. Bilateral p value of 0.05 was considered statistically significant.
Results
During this period, 22 patients were studied in the IG and compared to a CG of 37 patients. Table 1 shows the results of the effect of the NCM in the three main end-points.
| control* | intervention* | p valuec | |
| Time referral – first visit (days) | 16,6 | 7,6 | 0,022 |
| Time first visit – completion of last test (days) | 38,2 | 16,3 | 0,037 |
| Time completion of last test-initiation of treatment (days) | 45,0 | 24,4 | 0,044 |
Conclusion
The incorporation of a NCM for the diagnostic and follow up of patients with SMM has allowed to reduce time from referral to visit, completion of tests and initiation therapy in the IG when compared with CG. Data collected during follow-up suggests that NCM involvement may lead to a decrease in hospital costs, with a significant patient perceived satisfaction. Further observation is warranted to confirm our preliminary findings.
Session topic: E-poster
Keyword(s): Multiple myeloma, Quality control
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