A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization

Abstract

This study examined the extent to which cancer programs demonstrated adherence to their own prescribed screening protocol, and whether adherence to that protocol was associated with medical service utilization. The hypothesis is that higher rates of service utilization are associated with lower rates of adherence to screening protocols. Oncology social workers at Commission on Cancer-accredited cancer programs reviewed electronic health records (EHRs) in their respective cancer programs during a 2-month period in 2014. Rates of overall adherence to a prescribed distress screening protocol were calculated based on documentation in the EHR that screening adherence and an appropriate clinical response had occurred. We examined documentation of emergency department (ED) use and hospitalization within 2 months after the screening visit. Review of 8,409 EHRs across 55 cancer centers indicated that the overall adherence rate to screening protocols was 62.7%. The highest rates of adherence were observed in Community Cancer Programs (76.3%) and the lowest rates were in NCI-designated Cancer Centers (43.3%). Rates of medical service utilization were significantly higher than expected when overall protocol adherence was lacking. After controlling for patient and institutional characteristics, risk ratios for ED use (0.82) and hospitalization (0.81) suggest that when overall protocol adherence was documented, 18% to 19% fewer patients used these medical services. The observed associations between a mandated psychosocial care protocol and medical service utilization suggest opportunities for operational efficiencies and costs savings. Further investigations of protocol integrity, as well as the clinical care models by which psychosocial care is delivered, are warranted.

Suicide risk among cancer survivors: Head and neck versus other cancers

“…Cancer October 15, 2018 in 55 cancer centers indicated that less than two-thirds of patients were screened. 52,54,55 The psychosocial literature indicates that screening for psychological distress may be inadequate, 56 and it is particularly difficult to screen for a low-incidence outcome like suicide. 57 Furthermore, many physicians may not be comfortable discussing psychosocial issues like suicide with patients or their relatives.…”

Cancer patients' motives for psychosocial consultation—Oncology social workers' perceptions of 226 patient cases

“…There are no regulations about the number of sessions patients have the right to, and thus the number of sessions might be rather high, especially compared to countries with different health insurance systems (eg, the United States) and with less funded social work services at hospitals. Furthermore, Swedish OSWs are usually not involved in discharge planning or screening patients for distress, which seem to constitute important functions of OSWs in other countries . Instead, the main function of Swedish OSWs consists of providing psychosocial support and counselling .…”

Effects on patient-reported outcomes of “Screening of Distress and Referral Need” implemented in Dutch oncology practice

“…As not all patients who receive a referral actually follow through with the referral, patients who do take up treatment should be followed separately from those who do not. In addition to researching the effects of distress screening, referral, and take up of services, future studies should also investigate possible reduction in utilization of medical services and associated costs [25].…”