LEBANON, NH - Telemedicine has been growing as a key mode of providing care to patients in rural areas. Now, the COVID-19 pandemic has led to an exponential increase in need to deliver care to patients with cancer and other chronic conditions remotely. However, this extremely rapid expansion of telemedicine services has unknown effects on telemedicine capacity and adoption in the post-pandemic period.
The National Cancer Institute (NCI) has awarded a $204,000 supplemental grant to Dartmouth's and Dartmouth-Hitchcock's Norris Cotton Cancer Center (NCCC) for research surrounding sustainability of telemedicine for rural cancer patients. The research will be co-led by cancer population scientists Drs. Tracy Onega and Anna Tosteson.
Onega's and Tosteson's team will utilize the explosive growth of telemedicine resulting from COVID-19 as a natural experiment from which they can learn what factors allow telemedicine to be sustained over time, what adaptations need to take place to do so, and the impact this shift in care delivery modes has on patients.
"The ongoing telemedicine services provided by the Dartmouth-Hitchcock Center for Telehealth and Connected Care have increased almost 25-fold since the pandemic began, and many clinical care teams have transformed to mostly telemedicine appointments," says Onega. "This shift of health care delivery to remote modes aligns with NCCC's ongoing catchment area work and provides a unique opportunity to study the impacts of expanded telemedicine capacity."
The NCI Supplement to Cancer Center Support Grant will be awarded to Principal Investigator and NCCC Director Steven D. Leach, MD. "Within weeks of confirmed COVID-19 patients in our region, NCCC providers from most ambulatory services transitioned to televisits for a large portion of patients," says Leach. "A persistent increase in capacity and readiness to sustain telemedicine care delivery may be a positive unintended consequence of the pandemic."
The project, entitled "COVID-19 Pandemic: Natural Experiment in Rural Cancer Care Telemedicine Capacity Building," will be carried out by a multi-disciplinary team that includes leaders from across Dartmouth-Hitchcock Health and Dartmouth College. Team members include Dr. Kevin Curtis, Director of Connected Care; Dr. Sandra Wong, Chair of Surgery; Dr. Sally Kraft, VP for Population Health; Dr. Konstantin Dragnev, Associate Director for Clinical Research at NCCC; and Dr. Tor Tosteson, Director of NCCC's Biostatistics Shared Resource and Professor of Biomedical Data Science. The team is working to document changes during the COVID-19 pandemic in telemedicine capacity, use, and outcomes across the cancer care continuum. "This research is particularly exciting in that we're examining important, real-time and longitudinal impacts of the COVID-19 pandemic on cancer patients in our region," note Anna Tosteson and Onega.
Since the pandemic began, NCCC scientists have been repurposing and applying their skills and expertise toward not only developing new ways to diagnose and treat COVID-19, but toward innovating modifications that will allow NCCC providers to continue delivering cancer care safely to patients. "By leveraging Dartmouth-Hitchcock's telemedicine infrastructure and Dartmouth's expertise in health care delivery research and patient-centered care within a learning health system, we can generate key insights into ways to sustain and improve cancer care delivery via telemedicine for our rural catchment area," says Leach. "It has been immensely inspiring to see how our combined Dartmouth College, Geisel School of Medicine, and Dartmouth-Hitchcock Health research communities have partnered in action to help the nation through this crisis."
By studying the change in telemedicine capacity and related outcomes, Onega's and Tosteson's team will acquire a greater understanding of where telemedicine is best used to enhance the quality, ease, and safety with which cancer care is delivered across the continuum. The timeliness of this research allows a unique opportunity to learn the impacts of a public health crisis that will likely transform health care going forward.
Tracy Onega, PhD, is Associate Director for Community Outreach and Engagement and Co-Director of the Cancer Population Sciences Research Program at Dartmouth's and Dartmouth-Hitchcock's Norris Cotton Cancer Center; Professor of Biomedical Data Science, Director of the Division of Biomedical Informatics, and Professor of Epidemiology and of The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth. Her research interests include optimizing health care and outcomes for cancer patients and populations using biomedical informatics and geospatial methods.
Anna Tosteson, ScD, is Associate Director for Population Sciences and Member of the Cancer Population Sciences Research Program at Dartmouth's and Dartmouth-Hitchcock's Norris Cotton Cancer Center; Interim Director and Professor of The Dartmouth Institute for Health Policy and Clinical Practice; and James J. Carroll Professor of Oncology, Professor of Medicine, and Professor of Community and Family Medicine at the Geisel School of Medicine at Dartmouth. Her research interests include studying how innovations in biomedical science and health care delivery are changing the costs and outcomes of care with a focus on identifying best practices for advancing high-quality, patient-centered care.
About Norris Cotton Cancer Center
Norris Cotton Cancer Center, located on the campus of Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH, combines advanced cancer research at Dartmouth College's Geisel School of Medicine in Hanover, NH with the highest level of high-quality, innovative, personalized, and compassionate patient-centered cancer care at DHMC, as well as at regional, multi-disciplinary locations and partner hospitals throughout NH and VT,. NCCC is one of only 51 centers nationwide to earn the National Cancer Institute's prestigious "Comprehensive Cancer Center" designation, the result of an outstanding collaboration between DHMC, New Hampshire's only academic medical center, and Dartmouth College. Now entering its fifth decade, NCCC remains committed to excellence, outreach and education, and strives to prevent and cure cancer, enhance survivorship and to promote cancer health equity through its pioneering interdisciplinary research. Each year the NCCC schedules 61,000 appointments seeing nearly 4,000 newly diagnosed patients, and currently offers its patients more than 100 active clinical trials.