Distress Screening Adherence Results in Less Medical Resource Utilization, Cost Savings

Adherence to distress screening protocols could lead to 18% fewer ER visits and 19% fewer hospitalizations, according to a recent study published in Journal of the National Comprehensive Cancer Network (July 2017;15:903-912).


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Experiencing distress after a cancer diagnosis can play a large role in health outcomes, increase mortality and morbidity, and heighten health care expenditures through more frequent ER visits and hospitalizations. Recent mandates for routine distress screening at cancer centers were enacted by the Commission on Cancer to combat these negative effects of distress.

Brad Zebrack, PhD, MSW, MPH, University of Michigan Comprehensive Cancer Center, and colleagues conducted a study to examine the extent to which cancer programs (community and academic centers) demonstrated adherence to their distress screening protocols, and whether adherence to protocols was associated with medical resource utilization. Researchers reviewed electronic health record data from 55 cancer centers during a 2-month period in 2014. They hypothesized that higher rates of resource utilization were associated with lower rates of screening protocol adherence.

Researchers found that the overall adherence rate of screening protocols across cancer centers was 62.7%, with the highest rates of adherence seen in community cancer programs (76.3%) and the lowest rates observed in National Cancer Institute-designated cancer centers (43.3%).

Furthermore, researchers reported that lower rates of screening protocol adherence resulted in significantly higher medical resource utilization than initially expected. After controlling for patient and institutional characteristics, risk ratios were calculated at 0.82 for ER visits and 0.81 for hospitalizations. When overall protocol adherence was documented, 18% to 19% fewer patients used these medical resources.

These findings, researchers concluded, indicate opportunities for more efficient cancer care resource use and subsequent cost savings. Further research regarding screening protocol integrity, along with clinical care models for delivering distress care, are needed.

“Just as we do not expect blood pressure screening alone to reduce symptoms of cardiovascular disease, we should not expect distress screening alone to improve outcomes,” said Dr Zebrack in a press release (July 13, 2017). “There must also be an appropriate clinical response when risk conditions are detected.”—Zachary Bessette