Waiting to Exhale: The Feasibility and Appropriateness of Home Blood Oxygen Monitoring in Oncology Patients Post–Hospital Discharge

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Abstract
PURPOSE: Pulse oximetry remote patient monitoring (RPM) post–hospital discharge increased during the COVID-19 pandemic as patients and providers sought to limit in-person encounters and provide more care in the home. However, there is limited evidence on the feasibility and appropriateness of pulse oximetry RPM in patients with cancer after hospital discharge. METHODS AND MATERIALS: This feasibility study enrolled oncology patients discharged after an unexpected admission at the Memorial Sloan Kettering Cancer Center from October 2020 to July 2021. Patients were asked to measure their blood oxygen (O 2 ) level daily during the hours of 9 am -5 pm during a 10-day monitoring period posthospitalization. An automated system alerted clinicians to blood O 2 levels below 93.0%. We evaluated the feasibility (>50.0% of patients providing at least one measurement from home) and appropriateness (>50.0% of alerts leading to a clinically meaningful patient interaction) of pulse oximetry RPM. RESULTS: Sixty-two patients were enrolled in the study, with 53.2% female patients and a median age of 68 years. The most prevalent malignancy was thoracic (62.9%). The feasibility metric was met, with 45 patients (72.6%, 45 of 62) providing blood O 2 levels at least once during the 10-day monitoring program. The appropriateness threshold was not met; of the 121 alerts, only 39.7% (48 alerts) was linked to a clinically meaningful interaction. CONCLUSION: This feasibility study showed that while patients with cancer were willing to measure blood O 2 levels at home, most alerts did not result in meaningful clinical interactions. There is a need for improved patient support systems and logistical infrastructure to support appropriate use of RPM at home.

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