Telehealth closing racial/ethnic disparities? Increased adherence with remote symptom monitoring using patient-reported outcomes (PROs) among Black and Hispanic patients with telemedicine compared to in-person visits.

Abstract

392 Background: Adherence with remote PROs in the real-world, non-clinical trial setting remains varied in pts with cancer. The rapid widespread telehealth into routine healthcare delivery raises concern for disparate impact on race/ethnic minorities. In this study, we sought to understand the impact of telehealth via electronic health record (EHR) on pt adherence with PRO-based remote symptom monitoring implemented through that same EHR portal. Methods: We queried a prospective institutional database of all PROs remotely delivered to our pts bw 1/1/18 - 12/31/21. Pts were divided into 2 time cohorts (pre-pandemic 1/1/18 to 3/31/20, mid-pandemic 4/1/20 to 12/31/21), their self-identified race/ethnicity, and age cohorts (AYA 15-39y, midage 40-64y, older adults 65y+). Then, one representative global symptom burden PRO measure used across different clinics was analyzed for completion in a representative month over 4 years, 2 pre- (Oct ’18, ‘19) and 2 mid-pandemic (Oct ’20, ‘21). We calculated descriptive statistics and compared (t-test, ANOVA) between time, race/ethnicity and age cohorts and independent variables. Results: Over 4 years, 93,875 unique patients received 1+ EHR-based remote PROs within their routine cancer care. Remote EHR-based PRO response rate almost doubled from pre-pandemic (35%, 12011 responders of 34742 pts) to mid-pandemic time (67%, 39812 of 59200 pts, p < 0.00001). Analysis of one global symptom burden PRO widely used at our institution pre- and during pandemic showed the response rates rising (56.7% pre-pandemic vs 84.9% mid-pandemic, p 0.0004) with the sharp rise traced to 2nd and 3rd quarters of 2020 (response rate, 42.4% vs 85%, p < 0.001), with the transition to telehealth. Within the representative 4m period, 2738 pts (1075 pts in 2 pre- & 1663 in 2 mid-pandemic months) were sent that PRO – median age 60y, range 17-94y; 290 AYA 15-39y, 1444 midage 40-64y, 1004 older adults 65y+. PRO response rate increased (52% pre- to 81% mid-pandemic) w more responding without reminders from clinic team (13% pre-pandemic to 79% mid, p < 0.001). Older adults saw the highest increases in PRO response rates up by 35% vs AYA up by 21% & midage up 27%, p 0.012). Response rate without clinic reminders increased significantly (AYA, by 71%, midage by 78%, senior by 61%, p < 0.00001). When further analyzing by visit type during pandemic, the increased PRO response rates are driven by telehealth where in-person PRO completion decreased by 19% (pre-pandemic 52%, during 33%) while pts who had an upcoming virtual visit had 94% PRO response rate (p < 0.00001). Conclusions: Pt adherence w PRO-based remote symptom monitoring increased during the pandemic due to telehealth with the greatest gains seen in racial/ethinic minorities, inc. Black and Hispanic patients with cancer.