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Updated: Jun 21, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Association of a Digital Clinical Decision Support Platform With Early Outcomes After Pediatric Allogeneic
Kanayo Collins Nwankwo1, Elizabeth Klein2, Eric Leroux3
1Stem Cell Transplantation and Cellular Therapy, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Pediatric Hematology and Oncology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, New York, New York.
Insights
Implementing a digital bedside hematopoietic cell transplantation (HCT) guideline platform significantly reduced hospital length of stay (LOS) in pediatric patients. Sustained use of this digital tool also showed a trend toward lower non-relapse mortality (NRM) without negative impacts.
Area of Science:
- Hematopoietic Cell Transplantation (HCT)
- Digital Health
- Clinical Decision Support
Background:
- Variability in supportive care practices after pediatric allogeneic HCT can lead to preventable morbidity.
- Digital clinical decision-support platforms offer potential for standardizing care, but data on outcomes after sustained implementation are limited.
Purpose of the Study:
- To assess the impact of sustained implementation of a digital bedside HCT guideline platform on early clinical outcomes in pediatric allogeneic HCT.
- To evaluate changes in length of stay (LOS) and non-relapse mortality (NRM) following the adoption of a digital HCT guideline platform.
Main Methods:
- A single-center retrospective cohort study analyzed data from three eras: pre-platform (2013-2018), wash-in (2019-March 2023), and sustained-use (April 2023-2025).
- Primary outcomes included adjusted inpatient length of stay (LOS) and non-relapse mortality (NRM), with relapse as a competing event.
- Statistical analyses involved gamma regression for LOS and Fine-Gray regression for NRM, adjusting for multiple covariates.
Main Results:
- Sustained use of the digital platform was associated with a 14% reduction in adjusted mean inpatient LOS (45.74 days) compared to the pre-platform era (53.32 days).
- A trend towards lower non-relapse mortality (NRM) was observed during the sustained-use era (24-month cumulative incidence 0.116 vs. 0.147 pre-platform), becoming statistically significant after adjustments.
- No significant increases in ICU admissions, 30-day readmissions, or differences in overall survival were noted across the eras.
Conclusions:
- Sustained adoption of a digital bedside HCT guideline platform correlated with improved outcomes, including shorter LOS and a signal for reduced NRM.
- The lack of improvement during the initial 'wash-in' period suggests an implementation-dependent association, warranting further investigation.
- Prospective, multicenter studies incorporating patient-level platform exposure and adherence data are recommended to confirm these findings.
Abstract:
Practice variation in supportive care contributes to potentially preventable morbidity after pediatric allogeneic hematopoietic cell transplantation (HCT). Digital clinical decision-support platforms may improve care standardization, but outcome data after sustained implementation remain limited. To evaluate whether sustained implementation of a digital bedside transplant guideline platform was associated with changes in early clinical outcomes after pediatric allogeneic HCT. We conducted a single-center retrospective cohort study of first allogeneic HCTs across 3 eras: preplatform (2013 to 2018; n = 200), wash-in (2019 to March 2023; n = 111), and sustained-use (April 2023 to 2025; n = 78), defined by stable clinical adoption. Main outcomes of interest were adjusted inpatient length of stay (LOS) and nonrelapse mortality (NRM), with relapse treated as a competing event. LOS was analyzed using gamma regression with log link. NRM was analyzed using cumulative incidence functions and Fine-Gray regression. Models used robust standard errors and adjusted for age, sex, malignant indication, HCT-CI ≥3, conditioning intensity, cord graft, and non-MSD donor. Sensitivity analyses for NRM additionally adjusted for malignant case mix and antithymocyte globulin timing. In the 3-era LOS model, wash-in was unchanged versus preplatform (ratio 1.006; 95% confidence interval [CI], 0.876 to 1.136; P = .927), while sustained-use was 14% shorter (ratio 0.858; 95% CI, 0.749 to 0.966; P = .018). Adjusted mean LOS was 53.32 days (95% CI, 48.82 to 57.82) in the preplatform era, 53.64 days (95% CI, 48.18 to 59.10) during wash-in, and 45.74 days (95% CI, 41.41 to 50.08) during sustained use. NRM cumulative incidence at 24 months was 0.116 in sustained-use versus 0.147 in preplatform (12 months: 0.087 versus 0.105), but 24-month estimates for the sustained-use cohort were interpreted cautiously because only 14 patients remained at risk at 24 months. Fine-Gray models comparing sustained-use versus preplatform showed lower NRM (subdistribution hazard ratio [SHR], 0.259; 95% CI, 0.062 to 1.080; P = .064), strengthening after adjustment for malignant case mix (SHR, 0.212; 95% CI, 0.054 to 0.826; P = .025) and ATG timing (SHR, 0.193; 95% CI, 0.047 to 0.794; P = .023). There was no evidence of increased intensive care unit admission (odds ratio [OR], 0.73; P = .391) or 30-day readmission (OR, 1.30; P = .457). Overall survival did not differ across eras (log-rank P = .743). Sustained adoption of a digital bedside HCT guideline platform was associated with shorter hospital LOS and a consistent signal toward lower NRM without adverse utilization or survival outcomes. The absence of similar improvement during wash-in supports, but does not prove, an implementation-dependent association. Prospective multicenter evaluation with patient-level platform exposure and adherence metrics is warranted.
