Telehealth closing racial/ethnic disparities?

Increased adherence with PRO-based remote symptom

monitoring among Black and Hispanic patients with telemedicine compared to in-person visits
Ishwaria M Subbiah, Neil C Nimmagadda, Utpala Daftary, Angela Peek, Sarah Christensen, Fernando Small, Brandon Vincitore, Sara Ali,
Lori Williams. University of Texas MD Anderson Cancer Center, Houston, TX

BACKGROUND RESULTS RESULTS RESULTS

PRO-based remote symptom
monitoring favorably impacts quality of
life, healthcare utilization, and overall
survival in patients with cancer.
However, remote PRO completion
rates outside of a clinical trial remained
widely varied. Widespread use of
telehealth in cancer care during the
pandemic raised our key questions:
KEY QUESTIONS:
1. Did telehealth impact other tech-
related health behaviors such as
adherence with remote symptom
monitoring?
2. Did use of this health technology
(i.e., remote symptom monitoring)
OVERALL RESPONSE RATES
93,875 unique patients over four years
received 1 or more remote PROs as a
part of their routine cancer care.
PRO response rates increased from
35% pre-pandemic (12011 of 34742
patients responding) to 67% during
pandemic (p <0.00001).
PATIENT-LEVEL RESPONSE
PATTERNS
To better understand response patterns,
we selected one representative global
health PRO tool used widely at our
institution and analyzed the completion
rates in one representative month each
of four years, two pre-pandemic (Oct
2018 & 2019) and two mid-pandemic
RESPONSE PATTERNS BY AGE
Across all 3 age cohorts, PRO
response rates increased: AYA up 21%,
mid-age up 27%, older adults up 35%,
p 0.012. PRO non-response rate
decreased: AYA by 21%, mid-age by
27%, older adults by 35%, p 0.01.
Patient response rates without
reminders to complete increased
significantly: AYA, by 71%, mid-age by
78%, older adults by 61%, p <0.00001.
RESPONSE PATTERNS BY
RACE/ETHNICITY
Highest increases in adherence were
noted across racial/ethnic minorities.
Overall PRO Response (%)
RESPONSE BY MODALITY OF
UPCOMING VISIT: VIRTUAL VS IN-
PERSON
When further analyzing by visit type during
pandemic, the improvements in overall
PRO response rates are driven almost
exclusively by telehealth.
PRO completion decreased by 19% (pre-
pandemic 52%, during 33%) in patients
with upcoming in-person visits while
patients who had an upcoming virtual visit
had 94% PRO response rate (p
<0.00001).
% Non-responders to remote PROs pre- & mid-
pandemic, by race/ethnicity and visit type
PRE-PANDEMIC MID-PANDEMIC: MID-PANDEMIC:
In-person Upcoming Upcoming

exacerbate age and racial & Pre- Mid- %

p
visits only IN-PERSON visits VIRTUAL visits

(Oct 2020 & 2021). pandemic pandemic Change % Non- % Non- % % Non- %
ethnic disparities in care? responders responders Change responders Change
Overall, 2738 patients received 1+ White 56% 82% ▲26% <0.0001
Overall 48% 67% ▲19% p 0.0007 6% ▼-42% p 0.0003
global health PRO in these 4 months: Black 45% 76% ▲31%
White 44% 66% ▲22% 5% ▼-39%
To that end, we investigated pre- and 1075 patients received 1378 PROs Hispanic 48% 79% ▲31%
Black 55% 74% ▲19% 8% ▼-47%
mid- pandemic remote PRO response in 2 pre-pandemic months Other 35% 79% ▲44%
Hispanic 52% 66% ▲14% 7% ▼-45%
patterns in routine cancer care. Asian/PI 46% 86% ▲40%
1663 patients received 1871 PROs Other 65% 67% ▲2% 0% ▼-65%

in 2 mid-pandemic months Overall PRO Non-Responders (%) Asian/PI 54% 53% ▼-1% 4% ▼-50%

METHODS Pre- Mid- %

PATIENT-LEVEL RESPONSE pandemic pandemic Change
p
We queried a prospectively maintained
database of all PROs remotely sent to PATTERNS White 44% 18% ▼-26% <0.0001 CONCLUSIONS
patients at our institution from 1/1/2018 to Median age was 60y, range 17-94y. 290 Black 55% 24% ▼-31% Substantially higher adherence with PRO-
12/31/2021. AYA 15-39 years, 1444 middle age 40- Hispanic 52% 21% ▼-31% based remote symptom monitoring was
64 years, 1004 older adults, aged 65 Other 65% 21% ▼-44% seen during the pandemic across all
Patients were classified into the pre- Asian/PI 54% 14% ▼-40% race/ethnicities and age groups.
years and above.
pandemic (1/1/18 to 3/31/20) or mid-
The global health PRO response rate Proportion responding without reminder to Increased adherence was significantly
pandemic (4/1/20 to 12/31/21) cohort. complete (%)
increased from 52% pre- to 81% mid- associated with upcoming virtual visits in
Response rates were analyzed by self- Pre- Mid- %
comparison to in-person visits.
pandemic. Non-responders dropped pandemic pandemic Change
p
reported race/ethnicity and age (AYA 15-
from 48% to 19% Increased adherence was seen in older
39y, mid-age 40-64y, older adults, 65y+). White 14% 80% ▲66% <0.0001
Response rate without reminders to Black 12% 75% ▲63% adults & racial/ethnic minorities,
We calculated descriptive statistics and highlighting the deeper implications of
complete increased from 13% to 79% Hispanic 10% 68% ▲58%
compared (t-test, ANOVA) using age, telehealth on cancer care.
mid-pandemic. Other 12% 79% ▲67%
race/ethnicity, and independent variables. Asian/PI 17% 84% ▲67%
Contact: Ishwaria Subbiah, MD isubbiah@mdanderson.org