scholarly journals The Use of Patient Reported Outcomes to Predict Unplanned Inpatient Hospitalizations and Emergency Department Visits in Cancer Patients Receiving Concurrent Chemotherapy and Radiation Therapy

2019 ◽  
Vol 103 (5) ◽  
pp. E20
Author(s):  
Amardeep S. Grewal ◽  
Peter Gabriel ◽  
Abigail Doucette ◽  
James M. Metz ◽  
Andrzej Wojcieszynski
Keyword(s):  
Emergency Department ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Concurrent Chemotherapy ◽  
Emergency Department Visits ◽  
Patient Reported ◽  
Inpatient Hospitalizations

Using a chatbot to reduce emergency department visits and unscheduled hospitalizations among patients with gynecologic malignancies during chemotherapy: a pilot study (Preprint)

2021 ◽  
Author(s):  
Ming-Yuan Huang ◽  
Chia-Sui Weng ◽  
Hsiao-Li Kuo ◽  
Yung-Cheng Su
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Usual Care ◽  
Cancer Patients ◽  
Text Messaging ◽  
Emergency Department Visits ◽  
Control Group ◽  
Gynecologic Malignancies ◽  
Patient Reported ◽  
Ed Visits

BACKGROUND A chatbot is an automatic text-messaging tool that creates a dynamic interaction and simulates a human conversation through text or voice via smartphones or computers. A chatbot could be an effective solution for cancer patients’ follow-up during treatment, and could save time for healthcare providers. OBJECTIVE We conducted a retrospective cohort pilot study to evaluate whether a chatbot-based collection of patient-reported symptoms during chemotherapy, with automated alerts to clinicians, could decrease emergency department (ED) visits and hospitalizations. A control group received usual care. METHODS Self-reporting symptoms were communicated via the chatbot, a Facebook Messenger-based interface for patients with gynecologic malignancies. The chatbot included questions about common symptoms experienced during chemotherapy. Patients could also use the text-messaging feature to speak directly to the chatbot, and all reported outcomes were monitored by a cancer manager. The primary and secondary outcomes of the study were emergency department visits and unscheduled hospitalizations after initiation of chemotherapy after diagnosis of gynecologic malignancies. Multivariate Poisson regression models were applied to assess the adjusted incidence rate ratios (aIRRs) for chatbot use for ED visits and unscheduled hospitalizations after controlling for age, cancer stage, type of malignancy, diabetes, hypertension, chronic renal insufficiency, and coronary heart disease. RESULTS Twenty patients were included in the chatbot group, and 43 in the usual-care group. Significantly lower aIRRs for chatbot use for ED visits (0.27; 95% CI 0.11–0.65; p=0.003) and unscheduled hospitalizations (0.31; 95% CI 0.11–0.88; p=0.028) were noted. Patients using the chatbot approach had lower aIRRs of ED visits and unscheduled hospitalizations compared to usual-care patients. CONCLUSIONS The chatbot was helpful for reducing ED visits and unscheduled hospitalizations in patients with gynecologic malignancies who were receiving chemotherapy. These findings are valuable for inspiring the future design of digital health interventions for cancer patients.

Do Patient-Reported Symptoms Predict Emergency Department Visits in Cancer Patients? A Population-Based Analysis

2013 ◽  
Vol 61 (4) ◽  
pp. 427-437.e5 ◽  
Author(s):  
Lisa Barbera ◽  
Clare Atzema ◽  
Rinku Sutradhar ◽  
Hsien Seow ◽  
Doris Howell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Population Based ◽  
Emergency Department Visits ◽  
Patient Reported

scholarly journals Patient‐Reported Outcomes Predict Future Emergency Department Visits and Hospital Admissions in Patients With Stroke

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Irene L. Katzan ◽  
Nicolas Thompson ◽  
Andrew Schuster ◽  
Dolora Wisco ◽  
Brittany Lapin
Keyword(s):  
Emergency Department ◽  
Patient Reported Outcomes ◽  
Prediction Models ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Mitigation Strategies ◽  
Increased Risk ◽  
Patient Reported ◽  
Ed Visits ◽  
Unplanned Admissions

Background Identification of stroke patients at increased risk of emergency department (ED) visits or hospital admissions allows implementation of mitigation strategies. We evaluated the ability of the Patient‐Reported Outcomes Information Measurement System (PROMIS) patient‐reported outcomes (PROs) collected as part of routine care to predict 1‐year emergency department (ED) visits and admissions when added to other readily available clinical variables. Methods and Results This was a cohort study of 1696 patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack seen in a cerebrovascular clinic from February 17, 2015, to June 11, 2018, who completed the following PROs at the visit: Patient Health Questionnaire‐9, Quality of Life in Neurological Disorders cognitive function, PROMIS Global Health, sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. A series of logistic regression models was constructed to determine the ability of models that include PRO scores to predict 1‐year ED visits and all‐cause and unplanned admissions. In the 1 year following the PRO encounter date, 1046 ED visits occurred in 548 patients; 751 admissions occurred in 453 patients. All PROs were significantly associated with future ED visits and admissions except PROMIS sleep. Models predicting unplanned admissions had highest optimism‐corrected area under the curve (range, 0.684–0.724), followed by ED visits (range, 0.674–0.691) and then all‐cause admissions (range, 0.628–0.671). PROs measuring domains of mental health had stronger associations with ED visits; PROs measuring domains of physical health had stronger associations with admissions. Conclusions PROMIS scales improve the ability to predict ED visits and admissions in patients with stroke. The differences in model performance and the most influential PROs in the prediction models suggest differences in factors influencing future hospital admissions and ED visits.

Do patient-reported symptoms predict for emergency department visits? A population-based analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6039-6039
Author(s):  
Lisa Catherine Barbera ◽  
Clare Atzema ◽  
Rinku Sutradhar ◽  
Hsien Seow ◽  
Doris Howell ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Symptom Assessment ◽  
Well Being ◽  
Population Based ◽  
Emergency Department Visits ◽  
Assessment System ◽  
Patient Reported ◽  
Symptom Scores ◽  
Ed Visits

6039 Background: Since 2007 in Ontario, Canada, the Edmonton Symptom Assessment System (ESAS) has been routinely used to assess symptoms in cancer patients in both ambulatory and home-care settings. The purpose of this study was to determine the relationship between individual patient symptoms, and their severity, with the likelihood of an emergency department (ED) visit. Methods: The cohort includes all cancer patients in Ontario who completed an ESAS assessment between January 2007 and March 2009. We linked multiple provincial health databases to describe the cohort and determine if an ED visit occurred within 7 days of the patient’s first ESAS. Multivariate logistic regression was used to determine the association between symptom scores (absent: score 0; mild: 1-3; moderate: 4-7; severe: 8-10) and the likelihood of an ED visit. Results: The cohort included 45,118 unique patients whose first assessment contributes to the study. 3.8% (n=1732) had an ED visit. The patients with ED visits were more likely to be men, to have lung or gastro-intestinal cancer, to have had recent radio or chemotherapy, and to have a shorter survival. The proportion of patients with ED visits increased from 2% to 10-12% as individual symptom scores increased from 0 to 10. Anxiety and depression were not associated with ED visits in the model, regardless of severity. Pain, nausea, drowsiness, appetite and shortness of breath with moderate or severe scores were associated with ED visits. Tiredness and wellbeing were the only symptoms to show a significant association for mild, moderate and severe scores. A well being score of 7-10 (reference score=0) had the highest odds ratio of 1.8 (95% CI 1.4-2.3). Conclusions: Worsening symptoms clearly contribute to ED visits. While specific symptoms like pain are obvious targets for management in the outpatient setting, constitutional symptoms like wellbeing or fatigue are associated with even higher odds. Though difficult to manage, such symptoms also warrant detailed assessment in order to optimize patient outcomes.

Phase III non-randomized controlled trial of PROMPT-Care, an eHealth intervention utilizing patient reported outcomes in routine clinical care: Impact on emergency department presentations.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6510-6510 ◽  
Author(s):  
Afaf Girgis ◽  
Ivana Durcinoska ◽  
Anthony Arnold ◽  
Nasreen Kaadan ◽  
Andrew Alexis Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Controlled Trial ◽  
Phase Iii ◽  
Control Group ◽  
Diverse Population ◽  
Patient Reported ◽  
The Impact

6510 Background: The significant impact of routine assessment and clinical utilization of patient-reported outcomes (PRO) on patient and survival outcomes and reduced emergency department (ED) presentations has been demonstrated in specific patient populations (e.g. advanced cancer). This controlled trial evaluated the impact of an eHealth system, PROMPT-Care, on ED presentations in a diverse population of cancer patients from four oncology treatments centers. Methods: All adult patients receiving cancer care (including adjuvant therapy and follow-up) were eligible, excepting those with a diagnosis of a hematological malignancy, insufficient English literacy or no internet access outside of the clinic. Intervention (PROMPT-Care) patients completed monthly online assessments comprising 61 items of distress, common symptoms and unmet needs, with PRO results electronically transferred into the electronic medical record (EMR). In “real-time”, the care team accessed patients’ PRO summary reports to guide their care, an email alert notified nurses of ongoing unresolved issues between visits, and patients received links to support self-management. Control group patients (n = 2,288) comprised the general cancer patient population receiving usual care at the participating cancer therapy centers. Multivariable negative binomial regression was used to compare between-group differences. Results: From April 2016 to March 2018, 345 eligible patients (mean age 62, 58% female, 27% stage IV) participated and were sent at least four assessments within the first six months on trial. On average, control patients had 30 ED presentations and PROMPT-Care patients had 21 ED presentations per 10,000 patient days. After adjusting for age, sex and stage of disease, PROMPT-Care patients had 26% (95% CI 0.2%, 57%) fewer ED presentations compared to the control group (p = 0.0483). Conclusions: The PROMPT-Care intervention resulted in significantly fewer ED presentations in a broad population of cancer patients, including those currently undergoing cancer treatment or are in follow-up, and patients with a wide range of tumor types. The results support its utility as an improved model for ongoing supportive care for a diverse population, with potential healthcare cost savings. Clinical trial information: ACTRN12616000615482.

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