1. “The New England Journal of Medicine” has recently recognized the results of the “HOPE, Personalized Day Hospital” project. In addition to assuming full support, has any hospital/country been interested?
Manuel Dómine (MD): Yes, centers from the Quirónsalud group and others, public and private at the state level, as well as from other countries, such as Brazil and Germany, have contacted us.
2. How would you explain the project to a patient who is diagnosed with cancer tomorrow?
MD: It is the system we use to administer treatments in the day hospital, which puts the patient at the center of the entire process. The oncologist schedules the most appropriate treatment and all appointments at the day hospital, and, at the assigned time, the analysis is taken, a questionnaire is completed, and a clinical assessment is made. If everything is correct, in less than five minutes the treatment is confirmed. All in a single appointment to optimize the patient’s time. In addition, he can be in permanent contact with his healthcare team from his home through our app, the Patient Portal, which increases the safety and efficacy of the treatment.
3. Have admissions for treatment toxicity been reduced?
Cristina Élez (C. É.): The average is 25%, although there are months when it is up to 38%. This is due to the standardization of the collection of adverse effects at the most critical moment, just before the administration of treatment, as well as the fact that we provide the patient with a tool that allows us to detect certain side effects in real time that could potentially be more serious if we do not treat them in advance.
4. And the request for unnecessary appointments between cycles?
C. É.: We have reduced them to 62%.
5. Regarding waiting times, how much have they decreased thanks to this project?
MD: The patients who received treatment through the standard circuit usually had to go through multiple tests, appointments, and waiting times that included laboratory tests, appointments with the oncologist, with the nurse, trips to the hospital, medication preparation, and time in waiting rooms. All this meant that the patient needed an average of 10 hours to receive the treatment and had to go to the hospital two or three times. With the HOPE project, the average duration of treatment has been reduced by 97%. Currently everything is done in the day hospital: it has gone from needing four appointments, four rooms and four waits to unify everything in a single appointment, in a single room and without any waiting, and with an average duration of two hours in an integrated practice unit (oncologist, nursing, pharmacy and laboratory), where the analysis is done and the results are obtained in less than five minutes.
6. Have you discussed how decreasing delays has improved clinical safety?
MD: HOPE has improved these parameters, also because it goes beyond the hospital and continues at the patient’s home, with 24-hour communication with him through the Patient Portal, in which a web dialogue is available to communicate with Nursing and his oncologist, as well as a virtual assistant (chatbot) that guides him through the different symptoms, possible toxicities and doubts that may arise. If it is urgent, it alerts the oncologist on call; if it is not, the system itself sends recommendations for the most frequent symptoms. If it is not urgent and an automated message cannot be given, the nurse is notified via the web dialog. The systematization in the collection of clinical data and the identification and early detection of adverse effects has managed to reduce serious adverse effects and admissions. All these aspects can have an impact by reducing the mortality of the patients that we are currently analyzing through the evaluation of health results and Big Data analysis of a large population of patients, since we care for more than 4,000 people with cancer per year.
7. It has been implanted for more than four years. During this time, what does the patient think about it?
MD: We have observed a great improvement in the experience and satisfaction of patients throughout their care process. We have gone from 75% to 95% of patients who would recommend this service, especially due to the reduction in waiting times and trips, as well as instant access to their healthcare team through the Patient Portal.
8. Does any country have a similar project?
C. É.: There are some countries and centers that have some similar aspect of the project, but not as a whole.
9. Can you tell us what the next steps of the project will be?
C. É.: We would like to continue working along the lines of putting the patient at the center of care processes. In this project we have improved what we do while the treatment lasts; Now we want to make progress on how to further personalize care with better follow-up once the patient has finished treatment. Also working on tools that allow us to be more precise when determining the best treatment for each person using Big Data and improving communication skills, shared decision-making…
10. Finally, they exceeded the objective with which the project was born: to reduce delays by 75%. Will they reach 100%?
C. É.: In 2023 we are already much closer to 100% than the 75% of 2021.