The financial requirements and time commitments of caregivers for autologous stem cell transplant recipients.

This study is a prospective evaluation of the time commitment and financial requirements of caregivers of autologous stem cell recipients during the period of inpatient hospitalization. Eligible patients identified one caregiver, and a one-page survey addressing the necessary time commitment and out-of-pocket expenses was completed by the caregiver at each visit. The caregivers of 40 patients participated (non-Hodgkin's lymphoma [n = 19], multiple myeloma [n = 18], Hodgkin's lymphoma [n = 2], or acute myelogenous leukemia [n = 1]). Caregivers included spouses (n = 35), partners/friends (n = 2), or family members (n = 3). Results were summarized for the patient's total length of stay. Each caregiver traveled a median of 829 miles over 17.8 hours. Out-of-pocket expenses varied greatly depending on whether a caregiver stayed in local accommodations (cohort 1; n = 11) or in the patient's hospital room (cohort 2; n = 29). Total expenses (median) for each caregiver in cohort 1 were dollar 849.35, including accommodations (dollar 560), gasoline (dollar 87.35), and food (dollar 202). Total expenses (median) for each caregiver in cohort 2 were dollar 181.15, including gasoline (dollar 70) and food (dollar 111.15). Each caregiver in cohort 1 lost a median of 43.5 hours of work compared with 8 hours for each caregiver in cohort 2. The results from this prospective study demonstrate that there is a significant financial and time requirement on the part of the caregiver when a family member or significant other is hospitalized for an autologous stem cell transplant.

Group medical appointments: organization and implementation in the bone marrow transplantation clinic.

Group medical appointments provide patients with prompt access to care, greater attention to their psychosocial needs, and increased time with their medical team. Care providers evaluate more patients with similar needs in a shorter period. Eligible patients (between 100 days and 3 years after autologous stem cell transplantation) were contacted to participate. The laboratory and radiographic results of each patient's completed reevaluation were entered into the electronic template office note before their visit. A group medical visit model, called a Physical Shared Medical Appointment (PSMA), was employed because this uses individual patient examinations followed by a group meeting. On the day of the visit, brief physical examinations were performed on each patient. A transplantation physician then met with the group of patients and answered questions. Patient satisfaction surveys were distributed upon completion of the group session. Each PSMA was limited to 10 patients to facilitate patient participation. Questions during the group meeting were general and applicable to all patients. At completion of the 2-hour visit, patient surveys indicated an extremely high level of satisfaction and the preference to attend a future PSMA. Issues discussed during the group meeting were pertinent to all transplant recipients, regardless of diagnosis. The PSMA model allows the patient to spend extended time with their care providers while providing the care providers an opportunity to discuss health issues with numerous patients during 1 appointment. The Dartmouth Transplant PSMA model is expanding to pretransplantation and postallogeneic transplant recipients.

Implementation of peripheral blood CD34 analyses to initiate leukapheresis: marked reduction in resource utilization.

BACKGROUND: Analysis of the peripheral blood (PB) C34 value may determine the optimal time to initiate leukapheresis. STUDY DESIGN AND METHODS: After selecting a threshold PB CD34 value of five CD34 + cells per microL to initiate leukapheresis procedure, a prospective analysis of 50 consecutive patients was initiated to identify the optimal time to initiate leukapheresis and its impact on costs and resource utilization. Clinical decisions were made to commence or to postpone leukapheresis with this PB CD34 threshold number. Based on PB CD34 values for each patient, the number of leukapheresis procedures, postponed or canceled, the number of CD34+ cells per kg, and the total number of cells collected were identified. Costs of mobilization were obtained from the hospital cost accounting system. RESULTS: In 13 months, 50 patients with a hematologic disorder underwent mobilization. There were 34 cancellations or postponements of collections due to a low PB CD34 value in 13 patients. By use of our identified costs per initial collection, this resulted in a savings of 67,660 US dollars. CONCLUSIONS: This prospective study defines how the implementation of the PB CD34 value results in costs savings. A low PB CD34 value canceled or postponed a significant number of leukapheresis procedures, resulting in a substantial cost savings. Use of the PB CD34 value should be the standard of care during mobilization and peripheral blood progenitor cell collection.