ePRO-based digital symptom monitoring in a community oncology practice to reduce emergency room and inpatient utilization.
Authors: Kolodziej Michael A. , Kwiatkowsky Lavi , Parrinello Christina , Thurow Tracy , Schaefer Eric S. , Beck J. Thaddeus , Cherny Nathan , Blau Sibel 
Published: June 2022

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Background: We have previously reported on the successful implementation of an electronic patient-reported outcomes (ePRO)-based symptom monitoring tool in a community oncology practice. Basch et al reported that use of such a tool in the academic trial setting reduced ER visits and hospitalizations. We have examined the impact of the tool on ER and inpatient utilization in this real world patient population. Methods: Highlands Oncology Group (HOG) is a 21 physician oncology group located in Northwest Arkansas. Beginning in June 2020, HOG offered patients receiving parenteral cancer therapy enrollment onto Expain, an EMR-integrated ePRO system which enables remote symptom monitoring during therapy. EMR data were linked with the Arkansas State Health Alliance for Records Exchange (SHARE), the state’s Health Information Exchange (HIE), to obtain ER visits/hospitalization data. All patients at HOG treated between September 30, 2020 and November 30, 2021 were included in this analysis. Clinical and demographic characteristics were compared in patients who enrolled on Expain versus those who did not, and corresponding p-values were calculated using Mann-Whitney and Chi-square tests. Crude rates for ER visits / hospitalizations were calculated as the total number of events per total person-time. Results: There were 855 patients enrolled on the ePRO system. Concurrently, in the same practice, 1773 patients were treated but not enrolled. Reasons for non-enrollment included patient’s choice to not participate and patient not yet offered enrollment due to rolling enrollment. The non-ePRO cohort was slightly older (66.7 vs 63.3 yrs, p <.001), more commonly male (47.3% vs 39.3%, p <.001) and less likely to be White (85.3% vs 89.4%, p = 0.003). The cohorts were comparable with respect to cancer site distribution and included a diverse and representative distribution of common malignancies receiving systemic therapy in a community practice. The proportion of patients with metastatic disease was comparable (ePRO 52.9% vs non-ePRO 51.6%, p = 0.55). Health resource utilization rates were lower for patients in the ePRO cohort: ER visits: 1.72 vs 2.34 per 100 patient-months, rate ratio and 95% CI = 0.74 (0.60, 0.92), p-value = 0.005; hospitalizations: 4.76 vs 5.41 per 100 patient-months, rate ratio and 95% CI = 0.87 (0.77, 0.99), p-value = 0.04. Conclusions: Our findings confirm the substantial benefits of using an ePRO tool in reducing health care resource utilization, and extend the initial findings of previous publications in the academic, clinical trial setting to the real world setting. This observational data is subject to confounding factors and we are evaluating the robustness using various methods to address non-comparability of the cohorts. We are further examining the benefits in specific patient subsets and attempting to correlate these benefits with improved survival.