PO.PR01.05 · 预防研究
使用短信应答系统的化疗患者中参与度和医疗资源利用的预测因素
Predictors of engagement and healthcare resource utilization in chemotherapy patients using a text message response system
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：接受化疗的患者面临治疗相关并发症的高风险，常导致医疗资源利用（HCRU）增加。圣路易斯Mercy医院实施了一套短信应答系统（TRS），以主动捕捉患者报告的症状并促进及时的护理干预。我们评估了与TRS参与相关的人口学和临床因素及其与HCRU的关系。
方法：我们分析了来自三个州医院的3,899例患者数据（2025年1月至7月），其中包括2,750例TRS应答者和1,149例非应答者。评估的变量包括年龄、性别、种族、共病（脑血管疾病[CVD]、慢性阻塞性肺疾病[COPD]、肾脏疾病）、癌症类型和HCRU（急诊科[ED]就诊、住院[IP]收治）。统计分析采用Welch t检验、Pearson χ²检验、优势比（OR）及其95%置信区间（CI），并采用Holm校正进行多重比较。
结果：应答者略年轻于非应答者（平均年龄67.22 vs. 67.91岁，p=0.111）。女性患者更可能应答（73.2% vs. 67.5%；OR=1.31，95% CI 1.15-1.51，p=0.00010）。应答率在种族或共病方面无显著差异。癌症类型显示出轻微差异（χ²=19.77，p=0.011，Cramér's V=0.065），但校正后无成对差异仍存在。应答者的ED利用率更高（14.33% vs. 10.71%；OR=1.39，95% CI 1.12-1.73，p=0.0014），而IP收治率相似（15.96% vs. 16.10%，p=0.915）。主要的IP诊断包括脓毒症（41.94%）和贫血（38.4%），而疼痛（48.41%）和恶心（14.96%）在ED就诊中占主导。
结论：TRS参与度在女性和较年轻患者中更高，而老年人较不可能应答，提示需要采用替代性的外联策略，如直接电话联系。应答者表现出更高的ED利用率，主要因疼痛和恶心，但IP收治率相当。这些发现强调了有针对性干预的重要性——如输注中心支持和姑息治疗整合——以主动管理化疗相关症状并减少门诊环境中的HCRU。
查看英文原文 English abstract
Background: Patients receiving chemotherapy face a high risk of treatment-related complications, often leading to increased healthcare resource utilization (HCRU). Mercy Hospital, St. Louis, implemented a text message response system (TRS) to proactively capture patient-reported symptoms and facilitate timely nursing interventions. We evaluated demographic and clinical factors associated with TRS engagement and their relationship to HCRU.
Methods: We analyzed data from 3,899 patients across hospitals in three states (January-July 2025), including 2,750 TRS responders and 1,149 non-responders. Variables assessed included age, sex, ethnicity, comorbidities (cerebrovascular disease [CVD], chronic obstructive pulmonary disease [COPD], renal disease), cancer type, and HCRU (emergency department [ED] visits, inpatient [IP] admissions). Statistical analyses employed Welch t-tests, Pearson χ² tests, odds ratios (OR) with 95% confidence intervals (CI), and Holm correction for multiple comparisons.
Results: Responders were slightly younger than non-responders (mean age 67.22 vs. 67.91 years, p=0.111). Female patients were more likely to respond (73.2% vs. 67.5%; OR=1.31, 95% CI 1.15-1.51, p=0.00010). Response rates did not differ significantly by ethnicity or comorbidities. Cancer type showed modest variation (χ²=19.77, p=0.011, Cramér's V=0.065), though no pairwise differences remained after correction. ED utilization was higher among responders (14.33% vs. 10.71%; OR=1.39, 95% CI 1.12-1.73, p=0.0014), while IP admission rates were similar (15.96% vs. 16.10%, p=0.915). Leading IP diagnoses included sepsis (41.94%) and anemia (38.4%), while pain (48.41%) and nausea (14.96%) dominated ED visits.
Conclusions: TRS engagement was higher among female and younger patients, while older adults were less likely to respond, suggesting the need for alternative outreach strategies such as direct telephone calls. Responders demonstrated greater ED utilization, primarily for pain and nausea, but comparable IP admission rates. These findings underscore the importance of targeted interventions-such as infusion center support and palliative care integration-to proactively manage chemotherapy-related symptoms and reduce HCRU in the outpatient setting.
利益披露 Disclosure
S. Chennapragada, None.