Lay Health Worker-Led Cancer Symptom Screening Intervention and the Effect on Patient-Reported Satisfaction, Health Status, Health Care Use, and Total Costs: Results From a Tri-Part Collaboration

Abstract

PURPOSE: Poor patient experiences and increasing costs from undertreated symptoms require approaches that improve patient-reported outcomes and lower expenditures. We developed and evaluated the effect of a lay health worker (LHW)-led symptom screening intervention on satisfaction, self-reported overall and mental health, health care use, total costs, and survival. METHODS: From November 1, 2015, to September 30, 2016, we enrolled in this study all newly diagnosed Medicare Advantage enrollees with stage 3 or 4 solid tumors or hematologic malignancies who were receiving care in a community oncology practice. We evaluated symptom changes from baseline to 12 months for the intervention group. We compared with a control group (a historical cohort of Medicare Advantage enrollees diagnosed with cancer from November 1, 2014, to October 31, 2015) changes in satisfaction and overall and mental health with validated assessments at diagnosis and 5 months postdiagnosis, 12-month health care use, total costs, and survival. RESULTS: Among 186 patients in the intervention group and 102 in the control group, most were female and non-Hispanic white or Hispanic, and the mean age was 79 years. There were no survival differences between the groups. Relative to the control group, the intervention group experienced improvements in satisfaction with care (difference-in-difference: 1.35; 95% CI, 1.08 to 1.63), overall health (odds ratio, 2.23; 95% CI, 1.49 to 3.32), and mental or emotional health (odds ratio, 2.22; 95% CI, 1.46 to 3.38) over time; fewer hospitalizations (mean ± standard deviation: 0.72 ± 0.96 v 1.02 ± 1.44; P = .03) and emergency department visits per 1,000 members per year (0.61 ± 0.98 v 0.92 ± 1.53; P = .03), and lower median (interquartile range) total health care costs ($21,266 [$8,102-$47,900] v $31,946 [$15,754-$57,369]; P = .02). CONCLUSION: An LHW-led symptom screening intervention could be one solution to improve value-based cancer care.

Association of a Lay Health Worker Intervention With Symptom Burden, Survival, Health Care Use, and Total Costs Among Medicare Enrollees With Cancer

“…We excluded 1 clinic because it was involved in the previously reported intervention. 17 We enrolled all CareMore Medicare Advantage beneficiaries with newly diagnosed solid tumors or hematologic malignant neoplasms in these 9 clinics and excluded patients who did not receive medical oncology care. Patients were screened by a new patient coordinator, enrolled from November 1, 2016, to October 31, 2017, and followed up for 12 months after enrollment or until death, whichever was first.…”

“…15,16 A lay health worker (LHW)-led (ie, personnel who are not clinically trained) symptom screening intervention for adults with advanced cancer was previously developed. 17 The goal was to proactively identify symptoms to prevent psychological and physical distress and decrease acute care use. The LHW was trained to assess symptoms and relay them to a supervising physician assistant (PA), who conducted any necessary interventions.…”

Lay Health Workers’ Perspectives on Delivery of Advance Care Planning and Symptom Screening Among Adults With Cancer: A Qualitative Study

“…7 In 3 pilot projects across the United States, we demonstrated effectiveness of this approach on improved patient experiences with care, reduced cancer symptom severity, and reduced acute care use and total costs of care. [14][15][16] Between 2013 and 2016, 2 hospital-based and 3 outpatient community-based clinics implemented this program in their cancer clinics.…”

Additional Value of Patient-Reported Symptom Monitoring in Cancer Care: A Systematic Review of the Literature

“…All the studies were implemented in Europe and North America (ten of them in the United States and Canada). Of the 16 studies identified, eight had a randomized clinical trial design [ 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 ], six were observational studies [ 28 , 29 , 30 , 31 , 32 , 33 ] and two were economic evaluations [ 22 , 34 ]. Of the clinical trials, five reports [ 20 , 24 , 25 , 26 , 27 ] were randomized controlled trials with a high-quality design, whereas two [ 19 , 23 ] were research letters that communicated brief reports of data.…”

“…Among the observational studies, one had a retrospective matched cohort design [ 28 ], whereas four used a prospective-cohort design to examine the consequences of implementing a patient-reported symptom strategy in clinical practice [ 30 , 31 , 32 , 33 ]. The remaining study compared a patient-reported symptom strategy prospectively with a historical cohort [ 29 ].…”