A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization

Authors: Brad Zebrack PhD, MSW, MPH a , a , Karen Kayser PhD, MSW a , Deborah Bybee PhD a , Lynne Padgett PhD a , Laura Sundstrom MSW a , Chad Jobin MSW a and Julianne Oktay PhD, MSW a , a
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  • a From University of Michigan School of Social Work, and University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan; University of Louisville Kent School of Social Work, Louisville, Kentucky; Michigan State University, Lansing, Michigan; American Cancer Society, Atlanta, Georgia; University of Maryland School of Social Work, Baltimore, Maryland; and Association of Oncology Social Work, Oakbrook Terrace, Illinois.
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Background: This study examined the extent to which cancer programs demonstrated adherence to their own prescribed screening protocol, and whether adherence to that protocol was associated with medical service utilization. The hypothesis is that higher rates of service utilization are associated with lower rates of adherence to screening protocols. Methods: Oncology social workers at Commission on Cancer–accredited cancer programs reviewed electronic health records (EHRs) in their respective cancer programs during a 2-month period in 2014. Rates of overall adherence to a prescribed distress screening protocol were calculated based on documentation in the EHR that screening adherence and an appropriate clinical response had occurred. We examined documentation of emergency department (ED) use and hospitalization within 2 months after the screening visit. Results: Review of 8,409 EHRs across 55 cancer centers indicated that the overall adherence rate to screening protocols was 62.7%. The highest rates of adherence were observed in Community Cancer Programs (76.3%) and the lowest rates were in NCI-designated Cancer Centers (43.3%). Rates of medical service utilization were significantly higher than expected when overall protocol adherence was lacking. After controlling for patient and institutional characteristics, risk ratios for ED use (0.82) and hospitalization (0.81) suggest that when overall protocol adherence was documented, 18% to 19% fewer patients used these medical services. Conclusions: The observed associations between a mandated psychosocial care protocol and medical service utilization suggest opportunities for operational efficiencies and costs savings. Further investigations of protocol integrity, as well as the clinical care models by which psychosocial care is delivered, are warranted.

Author contributions: Study conception and design: all authors. Acquisition of data: all authors. Analysis and interpretation of data: all authors. Drafting of manuscript: all authors.

Correspondence: Brad Zebrack, PhD, MSW, MPH, University of Michigan School of Social Work, 1080 South University, Ann Arbor, MI 48109-1106. E-mail: zebrack@umich.edu
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