FIX IT prize winner 2023: My Clinical Outcomes (MCO)
The Fix IT in Healthcare Prize rewards excellent innovation in digital healthcare, particularly digital initiatives that have, or promise to, improve patient safety and staff well-being within the NHS or healthcare more widely.
Dr Ollie Minton, Rob Herriott and Tim Williams are the winners of the 2023 prize for their work on PROMs using the My Clinical Outcomes (MCO) website. In September 2020, University Hospitals Sussex NHS Foundation Trust (UHS) implemented an Enhanced Supportive Care (ESC) trial with patients with cancer identified to possibly benefit from earlier access to supportive care identified by a new team on the acute wards. These patients were offered the use of the My Clinical Outcomes (MCO) web-app.
MCO is a patient and clinician-facing web-platform for remote, long-term collection and real-time analysis of PROMs in routine clinical practice.
As part of this trial MCO was configured to prompt patients by email to complete three PROMs assessments routinely every 2 weeks via MCO, but could do so more frequently if desired. Result and progress were made available in real-time to the clinical team and were available for patients themselves to track. The PROMs included were:
- EORTC QLQ-C30 - a 30 question assessment of health-related quality of life for people living with cancer focussing on common physical, financial, social, cognitive and emotional impacts of disease.
- EQ-5D-3L and EQ-5D VAS - a 5 question assessment of mobility, self-care, ability to continue usual activities, pain / discomfort and anxiety / depression a visual analogue scale.
In this study patients benefitted from 5% fewer unplanned admissions with hospital stays also shorter by an average of 1.43 days. Furthermore, the results showed a return on investment with a benefit cost ratio of 1.4. Analysis by Unity Insights suggested that if the service was expanded for the South-East region the programme would deliver approximate savings of £11.2m over the course of five years.
At the time of writing work is underway to integrate MCO with University Hospitals Sussex and Sussex ICS systems, specifically the Our Care Connected ‘Plexus’ Portal with a plan to expand scope to include implementing around Virtual Wards, Patient Initiated Follow-Up and Elective Backlog Prioritisation initiatives, and plugging into the NHS app, to make the technology available to help support more patients in the region and more broadly.
What is the evidence behind this kind of approach?
The clinical evidence behind electronic symptom tracking by patients is growing. One game-changing study from the USA, revealed that remotely tracking PROMs in advanced cancer, helped clinicians better support patients, leading to nearly one third reporting improved quality of life and physical function, a reduction in emergency room visits by 7% and, most importantly, patients living on average five months longer overall.
Shortly after this research was published, the “Cancer Innovation Challenge” was launched in Scotland looking for New Approaches to Record and Integrate Cancer PROMs and PREMs. MCO was one of five companies to win the initial award and one of two chosen to go on to implement the new technology from February 2018.
More recently, a study published in the BMJ Supportive & Palliative Care entitled Cancer centre supportive oncology service: health economic evaluation revealed that patients with treatable but not curable cancers who receive a supportive care service that allows them access to MCO, had 0.95 fewer unplanned admissions per patient with hospital stays shorter by an average of 1.43 days. The results also illustrated a return on investment - for every £1 invested in the scheme, £1.40 was forecasted to be saved by the healthcare system.
What is more, a further analysis showed that if the technology enabled service was implemented across the whole of the South-East of England, the NHS could save c.£11.2M over 5 years. The authors of the BMJ paper recommended that the new service should be introduced to all NHS cancer patients.
What have people said about MCO and / or similar approaches?
Dr Catherine Calderwood, Scotland’s former Chief Medical Officer, has said: “Getting accurate information from patients about their symptoms at the time they are experiencing them is …particularly pertinent for people with cancer. How they feel really matters. Patient reported outcomes (PROs) have the potential to enhance the quality of life for patients while they are going through treatment. Ultimately it is about improving services, treatments and outcomes for people with cancer.”
And Professor Jane Maher, former Chief Medical Officer at Macmillan Cancer Support, has said: "Routine collection of patient-reported outcomes improves survival of patients with advanced cancer - so let's get on with it!”
Dr Ollie Minton, Consultant in Palliative Medicine, who led the study, said: “Too often, patients feel like passengers on their own treatment journey, and we know that during routine appointments, only half of treatment and disease related issues get reported. By putting patients in the driving seat, at the centre of their own care, allowing them to remotely track and report their symptoms more frequently, and combining that with specialist, supportive care services - we were able to spot and tackle issues more quickly and this in turn improved their quality of life and reduced their need for emergency care, which saved the NHS money. If this new technology enabled service were to be implemented nationally, it would be transformational for cancer patients and potentially save the NHS millions.”
Professor David Bloomfield, Consultant Oncologist and Chairman of the Sussex Cancer Fund said: “Due to the sheer volume of patients seen every year, hospitals tend to only track process driven outcomes that are easy to measure, such as waiting times, length of stay and avoidable complications. While these are important, they do not capture the impact of disease on patients’ lives, and the success or otherwise of treatment, particularly as these measurements tend to end when patients leave the hospital. From the patient perspective, it can also take a huge amount of effort to arrange regular calls or appointments with a specialist, particularly if they are unwell following treatment, meaning symptoms sometimes go unreported.
“By providing a user-friendly, web-based platform, patients are more likely to accurately record how they are feeling – information that doctors can see instantly so they can decidewhether they need to check in on a patient. It also means doctors can analyse patient data to assist with treatment and see if therapies are having a benefit. What is more, it provides system level data – for example an analysis showed one of the most significant concerns was fatigue, indicating the need for new targeted support for patients”.
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- Cancer centre supportive oncology service: health economic evaluation
- A Short Report Examining the Introduction of Routine Use of
Patient-Reported Outcome Measures in a Mixed Oncology Population
- Enhanced Supportive Care: Evaluation overview
- The Rise of Supportive Oncology: A Revolution in Cancer Care