By identifying this patient’s risk of mortality, oncology practice Patient Care Coordinators were able to ensure appropriate symptom management and confirm advanced directives.
A 71-year-old woman with Stage III non-small cell lung cancer (NSCLC) was receiving a trial medication for her condition. The Cognitive Machine alerted the oncology practice’s Patient Care Coordinators that the patient was at risk for 30-day mortality and an avoidable hospital admission. Upon chart review, the care team realized that the patient had recently been admitted to the ER and was awaiting discharge to hospice. Without the Cognitive Machine, this information would not have made it to the Patient Care Coordinators because the referral to hospice was made by the hospital and not communicated to the oncology practice.
As a result, the care team was able to discontinue any trial medications, ensure appropriate symptom management while in hospice care, discuss and confirm the patient’s advanced directives, and reinforce the practice’s process of patient escalation to ensure patient-centered care.