750 - Patient Reported Outcome Measure (PROM)-based Electronic Health Record Screening for Functional Decline Among Patients with Cancer Increases Timely use of Rehabilitation Services Among Patients with Cancer

Objectives: The National Cancer Institute-funded EHR-Facilitated Cancer Symptom Control (E2C2) Trial was designed to test whether automated PROM-based function and symptom assessment via the EHR and linked, automated needs-matched referrals would increase participants’ timely receipt of appropriate rehabilitation.

Design: E2C2 used a population-level, stepped wedged, cluster randomized, pragmatic trial design to enroll 51,000 patients with solid or liquid cancers who were being treated by the Mayo Clinic Midwest Medical Oncology practices in Rochester and the Mayo Clinic Health System (MCHS). The 15 clusters were defined by cancer type in Rochester, and by clinic site in the MCHS. PROMs were assigned in both the control and intervention states with PROM scores auto-populating the EHR. The intervention state additionally included automated e-delivery of self-management and -referral information for moderate functional decline (4-6/10 on an 11-point numerical rating scale (NRS)), and the opportunity to work with a Care Manager to coordinate rehabilitation services for severe functional decline (>7/10).



Results: Between 3/29/2019 and 1/31/2023 among 51,000 E2C2 participants, 11,149 patients had 81,353 completed encounters in Physical Medicine and Rehabilitation. Rehabilitation referral rates were calculated during the control and intervention intervals. During the initial 6 months following activation of the PROM system, rehabilitation referral rates remained stable at ~1,000 per month. Thereafter a gradual, monotonic increase was noted among patients who reported NRS scores > 4. This time trend continued until a cluster transitioned from the control to the intervention state which afforded greater support for care navigation. Following a cluster’s activation of the E2C2 intervention, rates of rehabilitation referrals increased significantly and followed a curvilinear trajectory.

Conclusions: PROM-based EHR monitoring for functional decline increases timely rehabilitation referrals rates. The effect is more pronounced when PROM monitoring is linked to dedicated support.