Scaling digital patient navigation to improve access to multidisciplinary melanoma care.

Abstract

1528 Background: Multidisciplinary (multiD) melanoma care is associated with improved patient (pt) outcomes, yet access is variable due to geographic, informational, and system-level barriers. We previously reported preliminary single-center feasibility of engaging pts using a digital patient navigation platform (DPNP) that provides information about melanoma, cutaneous oncology subspecialists, and clinical trials. We now report results from a multi-site expansion evaluating engagement across academic (Johns Hopkins; JH) and regional health systems (RHS). Methods: In this IRB-approved study, adult pts recently diagnosed with melanoma at JH or at a participating RHS were identified monthly using ICD-10 codes. Pts who were not already receiving multiD melanoma care at JH were sent DPNP invitations via their electronic medical record (EMR)-based pt portal. The primary endpoint was clickthrough rate (CTR; % of eligible pts who clicked the link in the invitation), benchmarked against web-based healthcare messaging standards (7%); invitation of ≥183 pts per setting was targeted (one-sided 90% CI exceeding benchmark if CTR ≥7.5%). Secondary endpoints included conversion rate (registration after clickthrough; benchmark 10%) and subsequent pursuit of multiD melanoma care. Results: From Nov 2023 - Dec 2025, 194 eligible pts were identified at JH; from Dec 2024 - Dec 2025, 356 at RHS; all were sent DPNP invitations. CTR: 41% at JH (80/194, 95% CI 34.2%-48.5%), 30% at RHS (106/356, 95% CI 25.1%-34.8%). Conversion rates were 23% (18/80, 95% CI 13.9%-33.2%) and 25% (27/106, 95% CI 17.5%-34.9%), respectively. Of 45 total registrants, 42 (93%) provided demographic data: mean age 59.7 yrs (range 25-83), 55% female, melanoma stage 0-IV. Among 16 JH and 26 RHS registrants, 2 (13%) and 6 (23%), respectively, had high-risk (stage ≥II) melanoma warranting a multiD consultation. After registering, 2/2 (100%) and 0/6 (0%) high-risk pts sought multiD care. Median distance to JH was 45 miles and 100 miles for JH and RHS registrants, respectively. Conclusions: In this multi-site study, melanoma pt engagement with a DPNP significantly exceeded established benchmarks across academic and RHS, demonstrating scalability of EMR-integrated outreach. However, among pts with high-risk melanoma, transition to multiD care occurred more frequently at the academic center than in RHS, revealing setting-specific barriers to converting engagement into subspecialty care. These findings indicate that while digital navigation can effectively identify unmet need across care environments, patient-initiated pathways alone may be insufficient to close access gaps. In response, we are developing a clinician-facing platform designed to overcome informational and geographic barriers by enabling collaboration between community clinicians and multiD oncology teams, thereby facilitating delivery of subspecialty cancer care closer to home.