Department of Health Policy and Management, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC.
UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
J Clin Oncol. 2024 Jan 20;42(3):300-311. doi: 10.1200/JCO.23.00993. Epub 2023 Oct 28.
We retrospectively evaluated the clinical and economic impact of a program providing nonmedical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system.
We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or no-show) radiation therapy and infusion chemotherapy/immunotherapy appointments in the 180 days after treatment initiation. We used propensity weighting to estimate the effect of the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to conduct a cost-consequence analysis from the health system perspective in a hypothetical cohort over a 6-month time horizon.
Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (n = 715) had ≥1 no-shows and 28% (n = 378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI, 0.6 to 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 in US dollars per missed appointment averted, relative to not providing nonmedical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (n = 541) received program assistance, and only 14% (n = 223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits.
This study used a novel approach to retrospectively evaluate a nonmedical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients' nonmedical financial needs, particularly for those undergoing intensive radiation therapy.
我们回顾性评估了在一家大型东南公立医疗系统接受癌症治疗的患者中，实施非医疗性经济援助项目对治疗预约失约率的临床和经济影响。
我们使用患者电子健康记录、项目记录和癌症登记数据，在治疗开始后 180 天内，分析该项目对放射治疗和输注化疗/免疫治疗预约失约率的影响。我们使用倾向评分加权法，按治疗预约类型（放射治疗、输注化疗/免疫治疗）分层，估计项目的效果。我们开发了一个基于决策树的经济模型，从卫生系统角度在假设的队列中进行了 6 个月时间范围内的成本-效益分析。
在 2015 年至 2019 年期间接受放射治疗的 1347 名患者中，有 53%（n=715）至少有 1 次失约，28%（n=378）接受了项目援助。任何援助的获得与失约比例降低 2.1 个百分点（95%CI，0.6 至 3.5）相关，总体平均失约比例降低 51%。在当前的资助模式下，与不提供非医疗性经济援助相比，该项目预计每避免 1 次预约失约可节省卫生系统 153 美元。在接受输注化疗/免疫治疗的 1641 名患者中，有 33%（n=541）接受了项目援助，只有 14%（n=223）有≥1 次失约。该财务援助项目对输注就诊的失约比例没有显著影响。
本研究采用了一种新方法，对正在接受积极癌症治疗的患者的非医疗性财务援助项目进行了回顾性评估。研究结果支持为解决患者非医疗性财务需求的项目提供投资，特别是对那些正在接受强化放射治疗的患者。
