Author ORCID Identifier
Semester
Fall
Date of Graduation
2024
Document Type
Dissertation
Degree Type
PhD
College
School of Nursing
Committee Chair
Jennifer Mallow
Committee Member
Hannah Hazard-Jenkins
Committee Member
Roger Carpenter
Committee Member
Keshang Wang
Abstract
Background: Systemic chemotherapy is a cornerstone of cancer treatment, but it often leads to significant side effects, which may impact patients' quality of life and lead to increased acute healthcare utilization. Although patients are typically informed of potential symptoms and advised to seek care as needed, many struggle to understand and manage symptoms effectively. Patient-reported outcomes (PROs) have been shown to improve symptom monitoring, decrease symptom burden, and reduce emergency department visits and hospital admissions. Electronic patient-reported outcomes (ePROs), in particular, offer timely and accessible symptom tracking, though their effectiveness has largely been evaluated within urban clinical trial settings and outside of a real-time, patient and clinician-facing electronic health record. Thus, in 2022, clinicians in the West Virginia University (WVU) Cancer Institute, one of six major health systems to form the Symptom Management Implementation of Patient Reported Outcomes in Oncology (SIMPRO) Research Center, implemented the electronic symptom management (eSyM) intervention as part of routine oncologic care.
Aims: The research question that guided this study was “What is the difference in healthcare utilization for patients undergoing electronic symptom management (eSyM), compared to those undergoing standard care services in a rural, Appalachian medical oncology population?” The following aims stemmed from the research question: to describe the eSyM utilization, patient characteristics, and acute healthcare utilization of patients participating in eSyM (eSyM+ participants), those choosing not to participate in eSyM (eSyM- participants), and standard care participants; to explore the differences among patient eSyM+ participants, eSyM- participants, and standard care participants patient characteristics and acute healthcare utilization; to explore the relationship between the number of eSyM questionnaires answered and acute healthcare utilization; and to analyze the relationships among eSyM+ participants, eSyM- participants, and the standard care participants’ patient characteristics and acute healthcare utilization.
Method: A cross-sectional retrospective design was used to explore deidentified electronic health record (EHR) data of a convenience sample of patients initiating a new medical chemotherapy plan for thoracic, gastrointestinal, or gynecologic cancer in the WVU Cancer Institute, Mary Babb Randolph Cancer Center. Patients who satisfied inclusion criteria and completed at least one eSyM questionnaire were considered an eSyM+ participant. Data was stored and analyzed in SPSS version 29. Descriptive analyses were conducted and chi-square, Kruskal-Wallis, Spearman correlations, logistic regression, and linear regression were used to analyze the relationships among patient characteristics, eSyM utilization, and acute healthcare utilization.
Results: The participants were primarily of equal sex, older, white, and covered by government-funded health insurance. Acute healthcare utilization was overall high for all groups. Participants in the eSyM+ utilization group were more likely to have commercial or private insurance and experience hospital admission. Standard care participants and eSyM- experienced more
emergency department visits and hospital readmissions. The more questionnaires eSyM+ participants completed, the less likely they were to be admitted to the hospital. Having insurance was most likely to predict hospital admission in all three groups.
Conclusions: The use of ePROs such as eSyM offers promising benefits in rural, medical oncologic patients such as decreased acute healthcare utilization. However, sociodemographic features such as insurance continue to predict care patterns in underserved populations. Policymakers should focus on expanding insurance coverage, internet service, and access to digital health tools in these populations. Future studies should include a more diverse sample and aimed at exploring factors that impact eSyM participation.
Recommended Citation
Bailey, Andrea Ray, "Electronic Symptom Management Using PROs in a Rural, Appalachian Medical Oncologic Population" (2024). Graduate Theses, Dissertations, and Problem Reports. 12638.
https://researchrepository.wvu.edu/etd/12638