Improving cancer care for older adults: Updated results from a randomized clinical trial.
Notice bibliographique
Résumé
3 Background: Undertreated cancer symptoms are common among older adults, yet effective early intervention remains limited. In prior work, our team developed a proactive symptom assessment approach to reduce unwanted hospital use among older adults with cancer. In a cohort study, we demonstrated the intervention association on reductions in acute care use and total costs of care. The effect at scale remains unknown. Methods: We conducted this multi-site randomized trial across 43 community-based oncology clinics in California and Arizona between November 2020 through October 2023 with 12 months follow-up. Medicare Advantage beneficiaries ages 75 years or older with newly diagnosed cancer who were planning to receive care at any of the clinics were eligible. Participants were consented and randomized 1:1 into a control group (usual care alone) or intervention group (usual care with LHW-led proactive, telephone-based weekly symptom assessments for 12 months using the Edmonton Symptom Assessment System) with planned enrollment of 200 in both groups. The LHW reviewed assessments with an advanced practice practitioner who conducted any necessary intervention for symptoms that changed by 2 points or were rated 4 or greater. Outcomes were determined a priori. The primary outcome was emergency department (ED) use and hospitalizations. Secondary outcomes included total costs, hospice, and, among decedents, acute care use within 30 days of death and facility deaths. Semi-structured 30 minute interviews were conducted with patients, caregivers, clinicians, and payer representatives to inform future adoption. Results: Among 416 patients (216 control; 200 intervention) median age was 82 years (range 75-99); 205 (49.3%) were Hispanic or Latino, 10 (2.4%) African American or Black, 3 (0.7%) American Indian or Alaska Native, 12 (2.9%) Asian, 4 (0.9%) Native Hawaiian, 2 (0.5%) Pacific Islander, 180 (43.3%) Non-Hispanic White, 20 (4.9%) with multiple races; 219 (52.6%) were male; 171 (41.1%) had stage 4 disease. Intervention group participants had 53% lower odds of ED use (OR: 0.47, 95% CI 0.37-0.62), 68% lower odds of hospital use (OR: 0.32, 95% CI 0.20-0.51), and lower mean total costs of care by $12,000 USD per participant (p = 0.01) than control group participants. Among 142 deceased (71 in each group) the intervention group had 68% lower odds of acute care (OR: 0.32, 95% CI 0.12-0.88) and 75% lower odds of a facility death (OR 0.25; 95% CI 0.08-0.77). Patients noted positive experiences with the intervention, caregivers noted lower caregiver-burden, clinicians noted efficiency in care due to the between-clinic intervention aspects, and payers noted return on investment. Conclusions: This intervention may be a scalable, value-based approach to reduce acute care use for older adults with cancer. Clinical trial information: NCT04463992 .
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,034 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».