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Integration of patient-reported outcomes (PROs) for personalized symptom management in “real-world” oncology practices: a population-based cohort comparison study of impact on healthcare utilization

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Abstract

Background

The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in “real-world” oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame.

Methods

We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls.

Results

A small significantly lower Difference in Difference (DID) (− 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900–0.996); and a DID (− 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869–0.990). A lower DID in palliative care visits (− 0.0097), psychosocial oncology visits (− 0.0248), antidepressant prescriptions (− 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable.

Conclusion

Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale “real-world” trials.

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Acknowledgments

The iPEHOC study was funded by the Canadian Partnership Against Cancer (Toronto, Canada) with additional in-kind funding support from Cancer Care Ontario. This study was conducted with the support of the Ontario Institute for Cancer Research (OICR) through funding provided by the Government of Ontario. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The work of the entire team of iPEHOC research and project team members and our patient partners is acknowledged.

Disclosures

The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CCO and CIHI. However, the analyses, conclusions, opinions ,and statements expressed in the material are those of the author(s), and not necessarily those of CIHI or CCO.

Funding

This study was financially supported by the Ontario Institute for Cancer Research through funding provided by the Government of Ontario.

Author information

Authors and Affiliations

  1. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada

    Doris Howell & Madeline Li

  2. ICES, Toronto, Ontario, Canada

    Rinku Sutradhar, Sumei Gu, Javaid Iqbal, Clare Atzema, Craig C. Earle & Lisa Barbera

  3. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Rinku Sutradhar

  4. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada

    Mary Ann O’Brien

  5. Department of Oncology, McMaster University, Hamilton, Ontario, Canada

    Hsien Seow & Jonathan Sussman

  6. Department of Medicine and Oncology, Queen’s University, Kingston, Ontario, Canada

    Deborah Dudgeon

  7. Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Clare Atzema

  8. Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Craig C. Earle

  9. Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Carlo DeAngelis

  10. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

    Carlo DeAngelis

  11. Tom Baker Cancer Centre, Calgary, Alberta, Canada

    Lisa Barbera

  12. Division of Radiation Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary, Canada

    Lisa Barbera

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  1. Doris Howell
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  8. Deborah Dudgeon
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  13. Lisa Barbera
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Correspondence to Lisa Barbera.

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Howell, D., Li, M., Sutradhar, R. et al. Integration of patient-reported outcomes (PROs) for personalized symptom management in “real-world” oncology practices: a population-based cohort comparison study of impact on healthcare utilization. Support Care Cancer 28, 4933–4942 (2020). https://doi.org/10.1007/s00520-020-05313-3

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