COVID-19 后晚期癌症患者的远程医疗与医疗保健接触天数

Telehealth and Health Care Contact Days Among Patients With Advanced Cancer After COVID-19.

作者信息

Duffens Ali M, Zhu Shiyun, Shirazi Aida, Gupta Arjun, Liu Raymond

机构信息

Kaiser Permanente, San Francisco, California.

Division of Research, Kaiser Permanente Northern California, Pleasanton, California.

出版信息

JAMA Netw Open. 2025 Jun 2;8(6):e2516762. doi: 10.1001/jamanetworkopen.2025.16762.

DOI:10.1001/jamanetworkopen.2025.16762

PMID:40540268

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12181790/

Abstract

IMPORTANCE

The COVID-19 pandemic led to widespread telemedicine adoption, but its impact on time toxicity, ie, the time burden of interacting with the health care system, among patients with advanced cancer remains unclear.

OBJECTIVE

To evaluate the association of the COVID-19 pandemic with time toxicity for patients with advanced cancer who died within 1 year of diagnosis, focusing on changes in health care use, including telehealth.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients with stage 4 cancer who died within 1 year of diagnosis, with follow-up limited to 1 year. Patient data were provided by an integrated value-based health care system across Kaiser Permanente Northern California. Patients were grouped by diagnosis date into a pre-COVID-19 group (January 1, 2015, to February 29, 2020) and a post-COVID-19 group (March 1, 2020, to June 30, 2022, followed up through June 2023).

EXPOSURE

Health care use before and after the onset of the COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES

Time toxicity was measured as the percentage of health care contact days over survival days. Types of health care use included outpatient visits (in-person and telehealth), emergency department visits, and hospitalizations. Multivariable negative binomial regression was performed to assess use changes by care type.

RESULTS

The study included 9643 patients (median [IQR] age, 74 [66-81] years; 5119 men [53.1%]), with 6558 in the pre-COVID-19 group and 3085 in the post-COVID-19 group. Patients spent a median 32.5% (IQR, 21%-50.0%) of their days in contact with the health care system. In the post-COVID-19 group, in-person outpatient visits decreased (adjusted prevalence ratio [APR], 0.71; 95% CI, 0.69-0.74), while telehealth increased (APR, 2.01; 95% CI, 1.94-2.07). Overall contact days increased slightly (APR, 1.04; 95% CI, 1.02-1.07), as did emergency department and/or acute inpatient days (APR, 1.09; 95% CI, 1.04-1.15).

CONCLUSIONS AND RELEVANCE

In this cohort study of patients with advanced cancer, time toxicity remained high in the postpandemic era. Although telehealth increased, so did emergency department visits and hospitalizations. These findings highlight the need to integrate telehealth into time toxicity assessments to optimize patient-centered end-of-life care.

摘要

重要性

新冠疫情导致远程医疗被广泛采用，但其对晚期癌症患者的时间毒性（即与医疗系统互动的时间负担）的影响仍不明确。

目的

评估新冠疫情与诊断后1年内死亡的晚期癌症患者的时间毒性之间的关联，重点关注包括远程医疗在内的医疗服务使用情况的变化。

设计、设置和参与者：这项回顾性队列研究纳入了诊断后1年内死亡的4期癌症患者，随访期限制为1年。患者数据由北加利福尼亚州凯撒医疗集团的一个基于价值的综合医疗系统提供。根据诊断日期将患者分为新冠疫情前组（2015年1月1日至2020年2月29日）和新冠疫情后组（2020年3月1日至2022年6月30日，随访至2023年6月）。

暴露因素

新冠疫情爆发前后的医疗服务使用情况。

主要结局和测量指标

时间毒性以医疗接触天数占生存天数的百分比来衡量。医疗服务使用类型包括门诊就诊（面对面和远程医疗）、急诊科就诊和住院治疗。进行多变量负二项回归以评估不同护理类型的使用变化。

结果

该研究纳入了9643名患者（中位年龄[四分位间距]为74[66 - 81]岁；5119名男性[53.1%]），其中新冠疫情前组有6558名患者，新冠疫情后组有3085名患者。患者与医疗系统接触的时间中位数为其总天数的32.5%（四分位间距为21% - 50.0%）。在新冠疫情后组，面对面门诊就诊减少（调整患病率比[APR]为0.71；95%置信区间为0.69 - 0.74），而远程医疗增加（APR为2.01；95%置信区间为1.94 - 2.07）。总体接触天数略有增加（APR为1.04；95%置信区间为1.02 - 1.07），急诊科和/或急性住院天数也增加（APR为1.09；95%置信区间为1.04 - 1.15）。