Better Lives For the Very Sick

Doctors at UVA think some relatively commonsense changes can help very sick patients lead longer, happier lives.

Although the pilot program, called CARE Track (Comprehensive Assessment with Rapid Evaluation and Treatment), involves the use of new technologies and an online dashboard for patients and doctors, at its core the program seeks to ensure that the caregivers of seriously ill patients are communicating frequently with each other.

“An online dashboard will notify a clinician that a patient needs to see someone sooner,” explains Robert Goldstein, MD, associate professor of anesthesiology and pain medicine. “That is what we are going for: to start intervention earlier. Earlier attention to symptoms will improve the quality of life for the patient and their family, and hopefully reduce costs and hospitalizations.”

Although doctors do talk with each other, communication often relies on that hospital mainstay: the beeper.

Prevention-Minded

By putting greater emphasis on preventive care for very ill patients, CARE Track aims to gradually shift the nature of cancer care for those with advanced disease to one that focuses on symptom management, ideally preventing the sort of cancer-related complications that may lead to patients spending the twilight of their lives in a hospital.

“When patients get more advanced cancers, they are frequently managed more by the oncologist and chemo team,” says radiation oncologist Paul Read, MD, the leader of the program.  “And we were hoping to create more of the multispecialty care, team approach to manage these patients.”

Read says this can often mean more kinds of doctors considering a sick patient’s needs earlier in the process and discussing their care at weekly meetings.

“Anesthesiology/pain medicine and palliative care doctors have a lot to offer patients, but if they do not see the patient until they are bedridden or ready to go home to die, there are fewer options at that point,” says Read.

Breaking Down CARE Track

The program has three main components:

• An online dashboard called MyCourse that contains all of the latest information about a patient’s health, giving caregivers a central digital hub to view a patient’s health needs.
• The early inclusion of additional specialists — from palliative care physicians to anestheisiologists, social workers and dietitians — earlier in the cancer treatment process.
• The use of one large, targeted dose of radiation as opposed to the currently accepted practice of as many as 10 treatments. (It now appears that a single, targeted dose is equally effective for patients with painful cancer in their bones.)

The program has won $2.5 million in funding from the Centers for Medicare and Medicaid Services and is overseen by an advisory board that includes representatives from UVA and other major cancer centers.

Getting Going

Right now Leslie Blackhall, MD, MTS, Program Director for CARE Track and director of palliative care services, is busy devising the structure of much of the symptom recognition and notification alert portion of the program.

Patients with advanced cancers who join the program will answer online questions about their symptoms and well being each time they come to the hospital.

“What we are hoping is we can make these questions easy to use and simple,” says Blackhall. “And if we see that people are doing poorly, then the answer will be documented in their medical record and emails will go out to the doctors and nurses taking care of them as a call to action.”

The National Institute of Health devised the symptom management questions, according to Blackhall. The trick now is to implement the program in the way that makes the most sense for patients and caregivers.

“If we have a database that is showing us symptoms and what their functioning is in a centralized place where we all sit down and discuss, it will be much easier for us to effectively intervene in a coordinated way, with appropriate referrals” says Blackhall.

In addition to potentially saving time and money by treating symptoms early and preventing unnecessary hospital visits, early evidence suggests these kinds of palliative care interventions can help very ill patients lead longer lives.

“If you treat their pain, nausea, fatigue and their mood while you are treating their cancer, you tend to have better quality of life and may even help them tolerate their treatment more,” Blackhall says. “There was at least one study that suggested that it actually lengthened peoples’ lives.”

Blackhall says they will measure the effectiveness of the program to determine its value.

Beyond UVA

The CARE Track team expects some of the innovations in the program to have legs beyond Charlottesville.

If certain new, targeted technologies are shown to both reduce patient symptoms and healthcare costs, for instance, Goldstein says interest will spike.

For now, though, the doctors at UVA think some innovative changes may lead to better care for the very sick.

Says Read, “We need to start thinking about better ways of managing people before the end of life. This should be happening all the time.”