L. Theiss1, T. Wood1, I. Marques1, C. Shao1, R. Hollis1, K. Hardiman1, D. Gunnells1, J. A. Cannon1, M. S. Morris1, G. D. Kennedy1, D. I. Chu1 1University Of Alabama at Birmingham,Department Of Surgery,Birmingham, Alabama, USA
Introduction: Patient engagement technologies (PETs) are novel technologies that guide patients through the surgical journey, reduce costs of care and may lead to improved surgical outcomes. However, not all patients choose to enroll in a PET and the reasons are unclear. This study examines if patient demographics or insurance status are associated with patients declining to enroll in a PET.
Methods: Patients undergoing elective colorectal, thoracic, cardiac, and gynecological oncology surgery at a single institution were approached about enrolling in a PET (SeamlessMD) at their preoperative clinic visit. For patients who enrolled, healthcare reminders, educational content, PRO surveys, and health checks were distributed via the PET preoperatively, in-hospital, and for up to 30 days post-discharge. Patients who decided not to enroll were recorded and went through usual surgical care. Patient age, sex, race, and insurance status were compared between patients who elected to enroll in the PET at the initial clinic visit and patients who declined to enroll in the PET. Groups were compared using Wilcoxon signed rank test and independent t-test with alpha value of 0.05 determined a priori.
Results: Between 2018-2020, 1699 patients were approached about enrolling in the PET. 1609 (94.7%) elected to enroll, while 90 (5.3%) declined. Median age varied significantly between the groups, with median age of 60 for patients who enrolled compared to 66 for those who refused (p<0.001). Insurance status also varied significantly. Of patients who enrolled, 47.3% had Medicare/Medicaid, 41.8% were privately insured, and 10.9% were uninsured or charity care. Of patients who declined, 78.7% had Medicare/Medicaid and 21.4% of patients were privately insured (p<0.001). Patients who refused were more likely to be Black or African American, however this difference was not statistically significant (37.5% vs 30.7% for enrolled patients, p=0.24). There was no difference in PET enrollment by sex.
Conclusion: Older patients and patients who are not privately insured are more likely to decline PET enrollment. While PETs can be useful technology for navigating the surgical journey, they may not be universally adopted or provide benefit to all patients. Considerations should be made for complementary or alternative resources for these non-PET patients.