When Dr. Kirsten Nesset takes up her new position as an ILD specialist this fall at Kingston Health Sciences Centre in Kingston, Ontario, patient access to an ILD specialist in the large Kingston catchment area will effectively double. She will be joining Dr. Onofre Moran-Mendoza at the centre.
“Improving access to ILD specialists is one of the main goals, along with ILD research, of the CPFF Robert Davidson fellowship program,” says Sharon Lee, Executive Director of the Canadian Pulmonary Fibrosis Foundation (CPFF.)
Dr. Nesset will also hold an academic appointment as an assistant professor at Queen’s University. She’ll be teaching medical students and residents and continuing with her research. Part of that research will be completing the 12-month follow up with patients in her CPFF Fellowship project.
Dr. Nesset’s CPFF Robert Davidson Fellowship Research Project
Tune in as Dr. Kirsten Nesset shares the impact made by her CPFF Robert Davidson Fellowship and gives an update on her research project that explores how frailty might impact patient engagement and satisfaction in remote monitoring programs.
Preliminary Research Study Data
ATS Presentation, San Diego, May 2024
Dr. Nesset presented a poster of her research study to date, which included preliminary data gathered from 60 patients who completed 180 days or more of home-based data collection, at the American Thoracic Society (ATS) meeting in San Diego in May.
Titled The Effect of Frailty on Patient Engagement and Outcomes Using Remote Digital Monitoring in Interstitial Lung Disease, the study seeks to answer the question: Does frailty affect patient engagement and outcomes in remote digital monitoring in interstitial lung disease?
Research Study Method
Dr. Nesset manually reviewed 60 of the 150 ILD patient charts participating in a McMaster study called Connect ILD, which is investigating the feasibility of implementing a web-based remote monitoring platform called Seamless MD.
The data being collected during 12 months, includes:
- Health daily checks (HDC).
- Weekly device recording (WDR): measuring forced vital capacity (FVC) or home spirometry; and oximetry, which measure blood oxygen levels using an oximeter.
- Satisfaction surveys at 90 and 365 days.
- Quarterly Quality of Life questionnaires.
In order to answer her research question, Dr. Nesset reviewed the patient charts and assigned them a frailty “score” using the Clinical Frailty Score (CFS), a pictorial tool validated in retrospectively determining frailty status. Patients are categorized as Fit (CFS < 4), Vulnerable (CFS 4), and Frail (CFS 5-9).
The prevalence of any frailty (CFS 4-9) among the patients in the study was slightly more than 50 per cent.
Frailty does not affect patient engagement metrics
There was a single study drop-out due to death in a frail patient.
Adherence was not significantly different between fit and frail groups.
Frail patients have similar satisfaction, outcomes
Patients with frailty were less likely than “fit” patients to feel more confident in self-management of their disease, but just as likely as fit-rated patients to recommend remote monitoring.
There was no significant difference in Quality-of-Life scores.
The total numbers of calls to the healthcare team avoided (8 from 3 fit patients) or Emergency Department visits avoided (none) among all patients (fit or frail) – as self-reported – was minimal.
Conclusions
Higher confidence in self-management and decreased phone calls to health care teams among fit patients suggests a potential benefit of reassurance in those with less severe/stable disease.
Preliminary results suggest remote monitoring is a feasible care option in patients with ILD with any degree of frailty.
Trend to perform fewer HDC (health daily checks) and more WDR (weekly device recordings) in frail patients, which may reflect higher importance on physiologic monitoring.
What do theses early study results indicate?
For patients: “We are gathering useful information on how patients find remote interaction,” says Dr. Nesset. Patients can stay in touch no matter how unwell. Remote monitoring helps patients avoid burdensome travel with oxygen equipment and mobility issues and avoids exposure to waiting rooms.
For clinicians: The study informs clinicians of how frailty may affect engagement. “The results may help clinicians decide who they need to see more often, resulting in a more successful allocation of resources,” says Dr. Nesset.
For researchers: “In the overall Connect ILD study, researchers will be determining if the home spirometry data agrees with results gathered in-clinic, and if clinicians will be able to trust the home results,” she says. “Further investigation of the data will also help us decide which patients are best monitored remotely.”
What the CPFF fellowship has meant to Dr. Nesset and her future plans?
“The Robert Davidson Fellowship has made everything possible for me. I was able to engage in clinic and my research project, without taking time off to earn a living,” she says. “It has helped me secure a full-time position in Kingston and an academic appointment at Queen’s. I’m very excited to start this next phase of my career.”
The fellowship also introduced Dr. Nesset to the ILD health care professional community through online and in-person events in both Canada and the U.S. “I’m so pleased to be a part of improving ILD specialist care and to be part of the ILD patient advocacy community in Canada, “ she says.