Effect of post-discharge symptom monitoring on hospital readmissions: A randomized trial.

Abstract

1514 Background: There is growing interest to improve patient care transitions from hospital to home and to prevent readmissions but effective interventions are lacking. Methods: We conducted a randomized clinical trial among patients with cancer discharged after an unplanned hospital admission at a specialty cancer center. Hospitalized patients on medical oncology services were randomized at discharge to receive either a digital symptom monitoring and management intervention or to usual care. Patients randomized to the intervention received a daily electronic symptom assessment for 10 days post-discharge, consisting of 9 common symptoms from the National Cancer Institute Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events and an open-ended question to allow for patients to provide further symptom context and for two-way engagement with their clinical team. Patients also received customized self-management education delivered through the patient portal based on their reported symptoms. Primary oncologists received alerts through the portal for moderate and severe symptoms. Usual care consisted of symptom monitoring at the discretion of the primary clinical team, generally comprising an oncologist and an office practice nurse. The primary outcome was the 30-day readmission rate, analyzed using cumulative incidence functions and Gray’s test with death as a competing risk. Secondary endpoints included 90-day readmission rate and 30-day emergency room visit without admission rate. Results: Between 04/19 and 09/19/2024, 1,713 patients were randomized with median age 66 years (range: 19 – 99), 66% white, 12% African American, 11% Asian, and 11% Hispanic with 53% female. The most common cancer diagnoses were gastrointestinal (26%), thoracic (11%), genitourinary (10%), gynecologic (10%), leukemia (9%), and lymphoma (9%). In the intervention group, the most frequently reported moderate and severe symptoms were fatigue and pain. The two arms had roughly similar proportions of patients who died before a hospital readmission. The 30-day readmission rate was 30% in the intervention group compared to 37% in the usual care group (p = 0.001). The decrease in readmission rate was maintained at 90 days (45% vs. 52%, p = 0.002). Emergency room visits without admission at 30 days were also lower in the intervention group (12% vs. 17%, p = 0.007). Conclusions: Digital post-discharge symptom monitoring and customized patient self-management education for 10 days post discharge reduced hospital readmissions in patients with cancer. Further research is necessary to identify the precise mechanisms that contribute to the success of this intervention.