Development & Impact of a Virtual PSA Monitoring Clinic for Follow-up of Prostate Cancer Patients: An Efficient Model With Unique Benefits Relevant to COVID-19

PURPOSE/OBJECTIVE(S) To describe the development, clinical impact, financial impact, and patient satisfaction with a Virtual Prostate Cancer Clinic (VPCC) for follow up of patients treated for prostate cancer. MATERIALS/METHODS In 2015, we developed an algorithm-based, nurse-practitioner led, VPCC with a digital health platform (DHP) infrastructure to take the place of routine in-person follow-ups for men who had completed definitive treatment with prostate cancer. Virtual monitoring consisted of PSA at an affiliated lab reporting directly into our EHR or a local lab, and patient-electronically submitted AUA and EPIC-CP questionnaires. The DHP analyzed PSA levels to indicate relapse or no relapse, and provided symptom scores based on questionnaire responses. Interaction was either by telephone, secure email, SMS, or messaging through the electronic health record portal. Post-treatment symptoms were managed virtually and patients with evidence of PSA recurrence were worked up with appropriate scanning per guidelines and discussed with the referring physician. We analyzed clinical volume, financial data, and surveyed patients on their satisfaction. RESULTS From March 15, 2016, to July 31, 2020, a total of 1397 patients enrolled in the VPCC. 94.3% of patients were comfortable with this form of monitoring, with 3.4% neutral, and 2.3% uncomfortable. 92.4% saved time & 53.2% saved > 3 hours per visit. There were 702 in-person prostate cancer follow-up visits in FY15, but after the VPCC, this number was lower in each subsequent year by 13.5% (607) in FY16, 17.5% (579) in FY17, 21.0% (554) in FY18, and 24.0% (533) in FY19. Consults of all malignancy types conducted by radiation oncologists that treat GU malignancies on the main campus in FY15 were 534. Comparing pre-VPCC FY 15 to post-VPCC, we saw consult increases of 44.4% (771) in FY16, 45.5% (777) in FY17, 49.6% (799) in FY18, and 109.74% (1120) in FY19. GU new start volume in FY15 was 213, FY16 284, FY17 335, FY18 297, and FY19 382. Comparing pre-VPCC FY15 to post-VPCC, we observed increases of 33.3% in FY16, 57.3% in FY17, 39.4% in FY18, and 79.3 in FY19. There was no reimbursement for VPCC visits, but it increased physician availability for new patients and was associated with genitourinary radiation oncology revenue growth of 26.6%, 43.3%, 40.3%, and 74.4% for FY16, FY17, FY18, and FY19 compared to pre-VPCC FY15. Prior to Covid-19 (Oct-19: Feb-20), the FY20 monthly average was 26.4 referrals and 91.2 visits. During Covid-19 (Mar-20: Jul-20) dramatic increases in monthly referrals (59, +123%) and virtual visits (127, +39.3%) were observed. CONCLUSION The VPCC is a novel method of delivering follow-up care virtually with a DHP infrastructure that led to high patient satisfaction, significant patient time-savings, significant revenue growth from provider availability for new patients, and finally, we found that during the COVID-19 era, this model allowed for very rapid switching of patients from in-person follow-ups to virtual monitoring.