Lay Health Worker-Led Cancer Symptom Screening Intervention and the Effect on Patient-Reported Satisfaction, Health Status, Health Care Use, and Total Costs: Results From a Tri-Part Collaboration.
Manali I Patel, David Ramirez, Richy Agajanian, Hilda Agajanian, Jay Bhattacharya, Kate M Bundorf
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引用次数: 0
Abstract
Purpose: Poor patient experiences and increasing costs from undertreated symptoms require approaches that improve patient-reported outcomes and lower expenditures. We developed and evaluated the effect of a lay health worker (LHW)-led symptom screening intervention on satisfaction, self-reported overall and mental health, health care use, total costs, and survival.
Methods: From November 1, 2015, to September 30, 2016, we enrolled in this study all newly diagnosed Medicare Advantage enrollees with stage 3 or 4 solid tumors or hematologic malignancies who were receiving care in a community oncology practice. We evaluated symptom changes from baseline to 12 months for the intervention group. We compared with a control group (a historical cohort of Medicare Advantage enrollees diagnosed with cancer from November 1, 2014, to October 31, 2015) changes in satisfaction and overall and mental health with validated assessments at diagnosis and 5 months postdiagnosis, 12-month health care use, total costs, and survival.
Results: Among 186 patients in the intervention group and 102 in the control group, most were female and non-Hispanic white or Hispanic, and the mean age was 79 years. There were no survival differences between the groups. Relative to the control group, the intervention group experienced improvements in satisfaction with care (difference-in-difference: 1.35; 95% CI, 1.08 to 1.63), overall health (odds ratio, 2.23; 95% CI, 1.49 to 3.32), and mental or emotional health (odds ratio, 2.22; 95% CI, 1.46 to 3.38) over time; fewer hospitalizations (mean ± standard deviation: 0.72 ± 0.96 v 1.02 ± 1.44; P = .03) and emergency department visits per 1,000 members per year (0.61 ± 0.98 v 0.92 ± 1.53; P = .03), and lower median (interquartile range) total health care costs ($21,266 [$8,102-$47,900] v $31,946 [$15,754-$57,369]; P = .02).
Conclusion: An LHW-led symptom screening intervention could be one solution to improve value-based cancer care.
目的治疗不足症状带来的患者体验不佳和成本增加需要改善患者报告的结果并降低支出的方法。我们开发并评估了非专业卫生工作者（LHW）领导的症状筛查干预对满意度、自我报告的整体和心理健康、医疗保健使用、总成本和生存率的影响。方法从2015年11月1日至2016年9月30日，我们纳入了这项研究，所有新诊断为Medicare Advantage的3期或4期实体瘤或血液系统恶性肿瘤患者都在社区肿瘤诊所接受治疗。我们评估了干预组从基线到12个月的症状变化。我们与对照组（2014年11月1日至2015年10月31日被诊断为癌症的Medicare Advantage注册者的历史队列）进行了比较，并在诊断时和诊断后5个月、12个月的医疗保健使用、总成本和生存率进行了经验证的评估。结果在186例干预组和102例对照组患者中，大多数是女性和非西班牙裔白人或西班牙牙裔，平均年龄79岁。两组之间无生存差异。与对照组相比，随着时间的推移，干预组在护理满意度（差异：1.35；95%置信区间，1.08-1.63）、整体健康（比值比，2.23；95%可信区间，1.49-3.32）和心理或情绪健康（比值比，2.22；95%信息区间，1.46-3.38）方面有所改善；住院人数减少（平均值±标准差：0.72±0.96 vs 1.02±1.44；P=0.03），每1000名成员每年急诊就诊次数减少（0.61±0.98 vs 0.92±1.53；P=.03），以及较低的中位（四分位间距）总医疗费用（21266美元[8102美元-47900美元]对31946美元[15754-57369]；P=.02）。结论LHW主导的症状筛查干预可能是改善癌症价值观护理的一种解决方案。
期刊介绍：
Journal of Oncology Practice (JOP) provides necessary information and insights to keep oncology practice current on changes and challenges inherent in delivering quality oncology care. All content dealing with understanding the provision of care—the mechanics of practice—is the purview of JOP. JOP also addresses an expressed need of practicing physicians to have compressed, expert opinion addressing common clinical problems.
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