Article
Improving post-cellular therapy care with an interdisciplinary, cross-regional, cross-sectoral, digital-aided approach
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Authors
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Martin Schneider
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, Dresden, Deutschland
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Katharina Egger-Heidrich
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, Dresden, Deutschland
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Gabriele Müller
- Universitätsklinikum Carl Gustav Carus Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Dresden, Deutschland
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Roman Schmädig
- Universitätsklinikum Carl Gustav Carus Dresden, Krankenpflege, Dresden, Deutschland
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Franziska Schmidt
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, Dresden, Deutschland
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Lynn Leppla
- Universitätsklinikum Freiburg, Klinik für Innere Medizin I, Freiburg im Breisgau, Deutschland; Universität Basel, Institut für Pflegewissenschaften, Basel, Schweiz
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Sabina De Geest
- Universität Basel, Institut für Pflegewissenschaften, Basel, Schweiz
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Alexandra Teynor
- Technische Hochschule Augsburg | Technical University of Applied Sciences Augsburg, Fakultät für Informatik, Augsburg, Deutschland
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Markus Wolfien
- Institut für medizinische Informatik & Biometrie (IMB), Medizinische Fakultät Carl Gustav Carus, Dresden, Deutschland; ScaDS.AI Leipzig (Center for Scalable Data Analytics and Artificial Intelligence), Leipzig, Deutschland
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Martin Sedlmayr
- Institut für medizinische Informatik & Biometrie (IMB), Medizinische Fakultät Carl Gustav Carus, Dresden, Deutschland; ScaDS.AI Leipzig (Center for Scalable Data Analytics and Artificial Intelligence), Leipzig, Deutschland
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Mathias Hänel
- Klinikum Chemnitz gGmbH, Klinik für Innere Medizin III, Chemnitz, Deutschland
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Vladan Vucinic
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie, Leipzig, Deutschland
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Jochen Schmitt
- Universitätsklinikum Carl Gustav Carus Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Dresden, Deutschland
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Uwe Platzbecker
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Hämatologie, Zelltherapie, Hämostaseologie und Infektiologie, Leipzig, Deutschland
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Johannes Schetelig
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, Dresden, Deutschland
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Martin Bornhäuser
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, Dresden, Deutschland
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Jan Moritz Middeke
- Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Klinik und Poliklinik I, Dresden, Deutschland
| Published: | September 10, 2024 |
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Outline
Text
Background: Allogeneic stem cell transplantation (alloSCT) and CAR-T-cell therapies (CAR-T) have markedly improved survival rates for patients with hematologic malignancies. Despite their success, these therapies come with significant toxicities that extend beyond the primary hospital stays, leading to frequent rehospitalizations, particularly in the first year post treatment initiation. This highlights the critical need for comprehensive follow-up care. However, the wide geographic distribution of patients and the growing number of cases are putting significant pressure on healthcare resources.
Objective: The study “Interdisciplinary, Cross-Regional, Cross-Sectoral, Digital-Aided Care of Patients with Hematological Diseases Following Innovative Cellular Therapy – SPIZ” seeks to improve patient outcomes by decreasing mortality and hospital readmission rates through an innovative, intensified, and digitally supported follow-up program.
Methods: A multidisciplinary team of hematologists, nurses, and health services researchers in collaboration with computer scientists developed a comprehensive follow-up program for alloSCT and CAR-T patients, incorporating digital tools for monitoring and communication. The program’s efficacy will be assessed through a prospective, 1:1 randomized clinical trial (RCT), comparing SPIZ with standard care across all three cellular therapy centers in Saxony. Primary endpoints include rehospitalization and mortality rates, enhanced by qualitative outcomes and a health economic assessment, in partnership with AOK PLUS, Saxony’s largest statutory health insurance provider.
Results: The RCT targets 302 patients, with the interventional arm (IA; n=151) receiving personalized and intensified management. This includes organizing outpatient clinic visits by case managers as well as home visits by nurse specialists in hematology/cellular therapy. Early follow-up includes consistent in-home evaluations of overall health, vital signs, and adherence to medication, with all data meticulously recorded in a specially tailored follow-up mobile app for daily review. IA patients also benefit from video consultations with psycho-oncologists, social workers, and hematologists. Furthermore, they will be included in multidisciplinary panel discussions to ensure a holistic care strategy. The RCT runs from January 1, 2024, to May 31, 2026.
Implication for research and/or (healthcare) practice: SPIZ represents a pioneering effort to boost the outcomes of cellular therapy patients through a comprehensive, interdisciplinary care plan that incorporates digital innovations. This forward-thinking model has the potential to be adapted to other areas and conditions. Subject to a favorable evaluation, there are plans to permanently adopt this follow-up scheme.
Funding: Innovationsfonds/Versorgungsforschung; Project name: SPIZ – Sektorenübergreifende Versorgung von Patient:innen mit hämatologischen Erkrankungen nach innovativer Zelltherapie; Grant number: 01NVF22108
