Background:Remote symptom monitoring via electronic platforms may identify patients at risk for unplanned acute care visits after surgery. Since 2016, the Memorial Sloan Kettering Cancer Center (MSKCC) has employed the Recovery Tracker (RT), a patient-reported outcome (PRO) system, for symptom monitoring after ambulatory procedures. In 2021, RT was extended to patients undergoing inpatient colorectal surgery.Objective:To evaluate the impact of RT implementation on urgent care utilization and readmission rates in patients undergoing elective inpatient colorectal surgery and to determine whether patient engagement with RT influences these outcomes.Methods:In this retrospective observational study at MSKCC, we compared patients undergoing elective colorectal surgery during the RT implementation period (March 2021–December 2022) to a historical control cohort (February 2019–February 2020). The primary outcome was a potentially unnecessary urgent care center (UCC) visits—defined as a visit not requiring inpatient admission. Secondary outcomes included 30-day readmission and survey engagement. Multivariable logistic regression was used for adjusted comparisons.Results:A total of 1941 patients in the RT cohort and 1206 in the control group met the inclusion criteria. The RT cohort had higher rates of UCC visits without admission (4.43% vs. 1.6%) and 30-day readmissions (9.74% vs. 6.88%). RT period surgery was independently associated with increased odds of UCC visits (OR 2.80, 95% CI 1.71–4.58,p< 0.0001) and readmissions (OR 1.43, 95% CI 1.09–1.88,p= 0.0098). Notably, RT users who completed at least one survey (70.2%) had significantly lower odds of readmission (OR 0.56, 95% CI 0.41–0.77,p= 0.0003) compared to non-responders.Discussion:Engagement with the RT system was associated with a 44% reduction in readmission risk, identifying non-responders as a vulnerable subgroup. While the overall rates of post-discharge care utilization increased after RT implementation, active participation in PRO reporting emerged as a protective factor.Conclusions:These findings highlight the need for strategies to promote engagement and support patients less likely to interact with remote monitoring tools. Non-response may signal barriers such as technological challenges or increased vulnerability, warranting proactive engagement strategies.
背景：通过电子平台进行远程症状监测，可能有助于识别术后存在非计划性急性医疗需求风险的患者。自2016年起，纪念斯隆-凯特琳癌症中心（MSKCC）开始采用名为“康复追踪器”（RT）的患者报告结局（PRO）系统，用于门诊手术后的症状监测。2021年，该系统的应用范围扩展至接受住院结直肠手术的患者。 目的：评估RT系统的实施对择期住院结直肠手术患者紧急医疗资源使用率和再入院率的影响，并确定患者对RT系统的参与度是否影响这些结局。 方法：本研究在MSKCC进行，为一项回顾性观察研究。我们将RT实施期间（2021年3月至2022年12月）接受择期结直肠手术的患者与历史对照队列（2019年2月至2020年2月）进行比较。主要结局指标是潜在不必要的紧急护理中心就诊，定义为无需住院的急诊就诊。次要结局指标包括30天再入院率和调查参与度。采用多变量逻辑回归模型进行校正后的比较分析。 结果：RT队列共有1941名患者，对照组有1206名患者符合纳入标准。RT队列中无需住院的紧急护理中心就诊率（4.43% vs. 1.6%）和30天再入院率（9.74% vs. 6.88%）均高于对照组。RT实施期间接受手术与紧急护理中心就诊（OR 2.80，95% CI 1.71–4.58，p < 0.0001）和再入院（OR 1.43，95% CI 1.09–1.88，p = 0.0098）风险增加独立相关。值得注意的是，在RT使用者中，完成至少一次调查的患者（占70.2%）与未回应者相比，再入院风险显著降低（OR 0.56，95% CI 0.41–0.77，p = 0.0003）。 讨论：参与RT系统与再入院风险降低44%相关，这提示未回应者是一个脆弱亚组。尽管RT实施后，出院后医疗资源总体使用率有所上升，但积极参与PRO报告成为一个保护性因素。 结论：这些发现强调，需要制定策略以提高患者参与度，并为那些不太可能与远程监测工具互动的患者提供支持。未回应可能预示着技术挑战或更高的脆弱性等障碍，因此需要采取主动的参与策略。
肿瘤(癌症)患者之家