Doris Howell1, Madeline Li1, Rinku Sutradhar2,3, Sumei Gu2, Javaid Iqbal2, Mary Ann O'Brien4, Hsien Seow5, Deborah Dudgeon6, Clare Atzema2,7, Craig C Earle2,8, Carlo DeAngelis9,10, Jonathan Sussman5, Lisa Barbera11,12,13. 1. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 2. ICES, Toronto, Ontario, Canada. 3. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 4. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Department of Oncology, McMaster University, Hamilton, Ontario, Canada. 6. Department of Medicine and Oncology, Queen's University, Kingston, Ontario, Canada. 7. Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 8. Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 9. Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 10. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. 11. ICES, Toronto, Ontario, Canada. lisa.barbera@albertahealthservices.ca. 12. Tom Baker Cancer Centre, Calgary, Alberta, Canada. lisa.barbera@albertahealthservices.ca. 13. Division of Radiation Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary, Canada. lisa.barbera@albertahealthservices.ca.
Abstract
BACKGROUND: The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in "real-world" oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame. METHODS: We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls. RESULTS: A small significantly lower Difference in Difference (DID) (- 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900-0.996); and a DID (- 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869-0.990). A lower DID in palliative care visits (- 0.0097), psychosocial oncology visits (- 0.0248), antidepressant prescriptions (- 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable. CONCLUSION: Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale "real-world" trials.
BACKGROUND: The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in "real-world" oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame. METHODS: We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls. RESULTS: A small significantly lower Difference in Difference (DID) (- 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900-0.996); and a DID (- 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869-0.990). A lower DID in palliative care visits (- 0.0097), psychosocial oncology visits (- 0.0248), antidepressant prescriptions (- 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable. CONCLUSION: Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale "real-world" trials.
Entities:
Keywords:
Emergency department utilization; Health services research; Hospitalization; Implementation science; Patient-reported outcomes; Symptom management
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