Evaluating mass implementation of digital health solutions to improve quality and reduce disparities in a large multisite community oncology practice.
Authors: Patel Amila Meera , Bhardwaj Arun , Basch Ethan , Hudson Kathryn Elizabeth , Escudier Susan Marie , Books Holly , Kaushik Bhanu , Pearson Ben , Bays Christopher , Townsend Sydney , Patt Debra A. 
Published: June 2022

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Background: There is a priority to accelerate the delivery of digital health solutions (DHS) to provide patients with enhanced means for accessing care, but lack of understanding of their utility in certain populations. There are concerns that equitable adoption translate into disparities. We sought to implement a portfolio of DHS across a large practice and characterize engagement across populations to enhance clinical informatics solutions that support care delivery. Methods: This is a retrospective evaluation of cancer patients who engaged with a portfolio of DHS between March 1, 2019 and January 15, 2022. We included four tools with opt-in and opt-out functionality: (1) a care management (CM) platform utilized by clinical staff to manage patient activities, (2) an electronic patient-reported outcomes (ePRO) remote monitoring program for tracking symptoms and oral adherence, (3) a patient portal (PP) for securely accessing patient health records, and (4) digital education (DE) for patients regarding disease and treatments. The engaged population was defined as the number of enrolled patients with at least one (1) record of triage activity, (2) completed ePRO assessment, (3) PP login, and (4) DE read activity, for each tool, respectively. The start of the index period was adjusted based on the first go-live date of each tool. We evaluated factors (age, gender, race/ethnicity, preferred-language, marital status, and distance from clinic) associated with patient engagement using Chi-Square test and multivariate logistic regression. Results: This analysis included a total of 267,375 unique patients. Of the enrolled population per tool, 172,840 (73.6%), 9,938 (67.7 %), 49,771 (79.2%), and 12,044 (56.9%) patients were engaged in CM, ePRO, PP and DE, respectively. The majority (>50%) of engaged patients were female, White and non-Hispanic/Latino, English-language, and aged 61-80 yrs. After adjusting for covariates, we observed that White and non-Hispanic/Latino [(CM: OR 1.15, ePRO OR 1.46, PP: OR 1.48, and DE: OR 1.36) and English-language (CM: OR 1.2, ePRO OR 1.67, PP: OR 1.8 and DE: OR 1.89) patients were significantly (p-value <0.001) more engaged compared to their counterparts. Male patients were less likely to be engaged in CM (OR: 0.79) and ePRO (OR: 0.65) but more engaged in PP (OR: 1.1) compared to females. No significant difference was observed in engagement between non-rural (<20 mile) vs. rural (≥ 20 miles) and in all age groups 21-40, 41-60, 61-80 and >80 years as compared to reference age of 0-20 years for any digital tools except CM. Conclusions: DHS can be used to support the cancer patient journey and we demonstrated high utilization in an array of sociodemographic variables in our population. However, tools designed and implemented with different populations in mind to reduce staff burden and lessen the digital divide should be further explored.