2018 ASCO Annual Meeting!
Session: Health Services Research, Clinical Informatics, and Quality of Care
Type: Oral Abstract Session
Time: Friday June 1, 2:45 PM to 5:45 PM
The effect of a lay health worker-led symptom assessment intervention for patients on patient-reported outcomes, healthcare use, and total costs.
Care Delivery/Models of Care
Health Services Research, Clinical Informatics, and Quality of Care
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr 6502)
Author(s): Manali I. Patel, David Ramirez, Richy Agajanian, Jay Bhattacharya, Arnold Milstein, Kate Bundorf, CareMore Research Group; Division of Oncology; Clinical Excellence Research Center; Stanford University School of Medicine, Stanford, CA; CareMore, Cerritos, CA; The Oncology Institute of Hope and Innovation, Downey, CA; Stanford University, Stanford, CA; Stanford University School of Medicine, Stanford, CA
Background: Rising cancer costs demand models that safely lower expenditures and improve patients’ experiences and outcomes. In response, we developed a risk-stratified proactive symptom assessment intervention which consisted of a lay health worker, supervised by a nurse practitioner, who telephonically assessed symptoms weekly for high-risk patients and monthly for low-risk patients. We implemented the intervention in an oncology group with collaboration from a health plan to test the effect on patient-reported outcomes, healthcare use and cost. Methods: We enrolled all newly diagnosed health plan beneficiaries with Stage 3 and 4 cancer from 11/2014 through 9/2015. We evaluated patient-reported satisfaction, emotional and mental health with validated assessments at enrollment and 5-months post-enrollment. We compared healthcare use and costs to all patients with Stage 3 and 4 cancer diagnosed from 11/1/2013-10/31/2014 (control). We assessed differences in demographic and clinical factors using chi-square and t-tests. To evaluate differences in healthcare use and costs we used generalized linear models adjusted for age, stage, co-morbidity, cancer diagnosis, and length of follow-up. Results: There were 186 patients in the intervention and 102 in the control. In both arms, median age was 78 years, 55% were female, and gastrointestinal malignancies were the highest proportion of diagnoses. There were statistically significant improvements in mental and emotional health (p < 0.05) and satisfaction with care (p < 0.05) at 5-months follow-up compared with baseline. Patients in the intervention had significantly lower mean number of inpatient admissions per quarter (0.72 vs. 1.02, p = 0.03); mean number of emergency department visits per quarter (0.61 vs. 0.92, p = 0.04), and lower median total healthcare costs ($22344 vs $28414, p = 0.03) as compared to the control.