远程症状监测联合电子患者报告结局对社区肿瘤学实践中住院、生存和成本的影响：德克萨斯两步研究。
Impact of Remote Symptom Monitoring With Electronic Patient-Reported Outcomes on Hospitalization, Survival, and Cost in Community Oncology Practice: The Texas Two-Step Study.
机构信息
Texas Oncology, Dallas, TX.
Navigating Cancer, Seattle, WA.
出版信息
JCO Clin Cancer Inform. 2023 Sep;7:e2300182. doi: 10.1200/CCI.23.00182.
PURPOSE
There is raising interest to implement electronic patient-reported outcomes (ePROs) for symptom monitoring to enhance the quality of cancer care. Step 1 of the Texas Two-Step Study demonstrated successful implementation of an ePRO system in >200 sites of service of a large community oncology practice. We now report step 2 of this study which evaluates the impact of ePROs on outcomes among patients enrolled in the Centers for Medicare & Medicaid Services' Oncology Care Model (OCM) program.
METHODS
This observational study focused on patients with metastatic cancer enrolled in OCM at large community oncology practice located in Texas between July 2020 and December 2020. Patients who completed ≥1 survey via the ePRO tool were included in the study group and were propensity score matched with patients in a control group. Adverse events (AEs; hospitalizations, emergency department visits, deaths) and total cost of care were a priori study outcomes. Mann-Whitney and chi-square tests compared continuous and categorical variables, respectively, with multivariable logistic regression for adjustment of covariates.
RESULTS
Of 831 patients with metastatic cancer, 458 matched patients (229/group) were identified, with 52% male and a mean age of 74 years. Mean total AEs were lower in the study group compared with control (0.98 1.41; = .007), with decreased hospitalizations (20% 32.5%; = .002), emergency visits (38.4% 42.3%; > .05), and deaths (11.8% 16.6%; > .05). Average number of hospitalizations was lower (0.28 0.52; = .003) with reduced mean duration of hospitalizations (1.9 vs 3.2 d; = .03). The total cost of care was reduced by an average of $1,146 per member per month.
CONCLUSION
Symptom monitoring with ePROs improved quality and value of cancer care delivery by reducing hospitalizations, emergency visits, and deaths while lowering cost of care in a large oncology practice.
目的
为了提高癌症护理质量，人们对实施电子患者报告结局（ePRO）进行症状监测的兴趣日益浓厚。德克萨斯两步研究的第一步成功地在一个大型社区肿瘤学实践的 200 多个服务站点实施了 ePRO 系统。现在，我们报告该研究的第二步，评估在德克萨斯州的一个大型社区肿瘤学实践中，参与医疗保险和医疗补助服务（Medicare & Medicaid Services，CMS）肿瘤学护理模式（Oncology Care Model，OCM）计划的患者中，ePRO 对结局的影响。
方法
这项观察性研究集中在 2020 年 7 月至 2020 年 12 月期间在德克萨斯州参与 CMS 肿瘤学护理模式计划的大型社区肿瘤学实践中患有转移性癌症的患者。通过电子患者报告工具完成了≥1 次调查的患者被纳入研究组，并与对照组的患者进行了倾向评分匹配。预先设定的研究结局是不良事件（hospitalizations、emergency department visits、deaths）和总护理成本。Mann-Whitney 和卡方检验分别用于比较连续和分类变量，多变量逻辑回归用于调整协变量。
结果
在 831 名患有转移性癌症的患者中，确定了 458 名匹配的患者（每组 229 名），其中 52%为男性，平均年龄为 74 岁。与对照组相比，研究组的总不良事件更低（0.98 1.41； =.007），住院（20% 32.5%； =.002）、急诊就诊（38.4% 42.3%； >.05）和死亡（11.8% 16.6%； >.05）的发生率降低。住院人数平均减少（0.28 0.52； =.003），住院时间平均缩短（1.9 vs 3.2 天； =.03）。每位成员每月的平均护理费用降低了 1146 美元。
结论
在大型肿瘤学实践中，通过使用电子患者报告结局进行症状监测，减少了住院、急诊就诊和死亡，同时降低了护理成本，从而提高了癌症护理的质量和价值。
Zotero 插件