Key takeaways:
- Use of an digital patient-reported outcome-based program didn’t considerably cut back ED or inpatient visits after most cancers remedy.
- Solely 51% of sufferers used this system to report signs.
CHICAGO — Affected person-reported outcomes collected by way of an digital well being record-integrated symptom administration program didn’t considerably cut back ED or inpatient admission occasions after most cancers remedy, in accordance with analysis.
Notably, solely half of sufferers reported signs utilizing the intervention, findings introduced at ASCO Annual Assembly confirmed. Researchers famous that well being care system implementation and affected person engagement limitations could have lowered this system’s effectiveness.
“The largest shock to me was the variations that we noticed by establishment,” Michael J. Hassett, MD, MPH, FASCO, chief high quality officer at Dana-Farber Most cancers Institute and affiliate professor at Harvard Medical Faculty, advised Healio. “We noticed two establishments that demonstrated a profit with the intervention, two the place the impact was the next price of acute care utilization and two the place it was secure. We simply weren’t anticipating to see such heterogeneity by website.”
Challenges persist
Digital patient-reported outcomes (ePRO) have been proven to cut back useful resource utilization whereas additionally enhancing outcomes for sufferers with most cancers. Nevertheless, challenges persist implementing ePROs in apply as a consequence of poor affected person engagement, workers limitations and technical deployment, amongst others.
Hassett and colleagues carried out a realistic stepped-wedge medical trial of an ePRO-based, EHR-integrated symptom administration system (eSyM) at six well being techniques to evaluate the first effectiveness end result of sufferers previous to and after the deployment of the eSyM.
Researchers carried out the research between January 2018 and February 2023.
The research included 39,942 adults who began chemotherapy or had been discharged following surgical procedure for suspected or confirmed gastrointestinal, gynecologic or thoracic most cancers.
The intervention arm included 18,830 sufferers (median age, 65 years; 63% ladies), and the management arm included 21,112 sufferers (median age, 62 years; 68% ladies).
Sufferers within the intervention arm responded to ePRO questionnaires primarily based on objects from the Affected person-Reported Outcomes model of the Frequent Terminology Standards for Adversarial Occasions, extreme symptom alerts, self-management tip sheets and communication assist.
About half (51%) of sufferers within the intervention arm used eSyM to report signs.
Tracked outcomes included an ED go to or inpatient admission inside 30 and 90 days.
Institutional variations
Information present crude 30-day occasion charges for the management and intervention arms of 5.4% and 6.2%, respectively, for ED visits (OR = 1.1; 95% CI, 0.94-1.29) and eight.5% and 9.1% for inpatient admissions (OR = 1; 95% CI, 0.88-1.14).
After accounting for different components, researchers famous no important variations in both end result at day 30 or 90.
Nevertheless, information did present considerably larger odds for sufferers discharged after surgical procedure to go to the ED within the intervention arm (OR = 1.23; 95% CI, 1.01-1.49). Researchers didn’t observe an identical pattern with regard to inpatient admissions.
When stratified by well being system, information present variance in odds for each ED visits (vary, 1.47-0.74) and inpatient admissions (vary, 1.59-0.71), with proof of upper, related and decrease odds for acute care occasions for each cohorts.
Hassett additionally famous that, on the 30-day mark, information present a slight enhance in ED visits amongst sufferers who had been discharged following surgical procedure, offering additional proof for a way the identical program can internet completely different outcomes relying on who implements it.
“It makes you marvel if possibly that the way in which surgeons cope with managing signs is simply completely different,” Hassett advised Healio. “Surgeons aren’t in clinic on a regular basis, so if we’re figuring out extra signs and we’re producing extra calls, which will result in extra use of the emergency room as a result of surgeons could also be much less prone to ship sufferers to clinic.
“That’s only a principle as to why figuring out extra signs may truly result in a bit of little bit of a rise in emergency division utilization,” he added. “The identical is true when you consider how completely different establishments handle signs. What number of nurses can be found to name again sufferers? What’s the staffing availability? Have they got late hours in infusion? Have they got weekend hours in infusion?”
Hassett famous that “all these structural points actually affect the usual method for a way you handle signs, and will have a giant impact on an intervention designed to enhance communication and consciousness of signs.”
For extra info:
Michael J. Hassett, MD, MPH, FASCO, will be reached at michael_hassett@dfci.harvard.edu.
Sources/Disclosures
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Hassett MJ, et al. Summary 11001. Introduced at: ASCO Annual Assembly; Could 30-June 3, 2025; Chicago.
Disclosures:
Hassett reviews no related monetary disclosures. Please see the research for all different authors’ related monetary disclosures.
