{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:57:37Z","timestamp":1782845857722,"version":"3.54.5"},"reference-count":51,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The US health care system faces escalating costs, increasing emphasis on patient autonomy, and a regulatory shift toward patient-centered care and patient-reported outcomes (PROs). Leveraging PROs to support shared decision-making has the potential to improve outcomes and reduce health care use for patients with advanced chronic conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to evaluate the impact of a PRO-based clinical dashboard on the use of costly health services among patients with advanced cancer and chronic kidney disease (CKD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a quasi-experimental, propensity score\u2013weighted, difference-in-differences analysis using routinely collected data (June 2020 to January 2022) from a large US academic health system. Dashboard users were compared with contemporaneous nonexposed patients matched on clinical criteria. The primary outcomes were unplanned all-cause hospital admissions, potentially avoidable emergency department visits, excess days in acute care within 30 days of discharge, and 7-day readmissions. Cancer-specific secondary outcomes included acute encounters during outpatient chemotherapy, oncology triage use, advance directive completion, and hospice use. CKD-specific outcomes were CKD-related acute care use and disease progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the advanced cancer cohort (dashboard users: n=284; dashboard nonusers: n=917), dashboard use was associated with significantly fewer chemotherapy-related emergency department or hospital encounters (ratio-in\u2013odds ratios 0.35, 95% CI 0.16-0.75) and a nonsignificant 1.7\u2013percentage point reduction in unplanned admissions (\u03b2=\u20130.017, 95% CI \u20130.107 to 0.072). Using Firth penalized logistic regression to reduce small sample bias, dashboard use was also associated with significantly higher odds of 7-day readmissions (ratio-in\u2013odds ratios 8.58, 95% CI 2.28-32.32). Among readmissions in the dashboard user group, most (13\/14, 93%) were scheduled by clinicians. Excess days in acute care increased by 4 percentage points (\u03b2=0.040, 95% CI \u20130.001 to 0.089). Advance directive completion declined significantly (\u03b2=\u20130.009, 95% CI \u20130.039 to 0.020). In the CKD cohort (dashboard users: n=365; dashboard nonusers: n=2137), no significant differences were observed for any primary or CKD-specific outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In routine oncology practice, a PRO dashboard was associated with fewer acute care encounters during chemotherapy but more planned early readmissions. The dashboard had no measurable effect on patients with CKD. These disease-specific mixed results highlight the need to tailor dashboards to the clinical context and embed them within workflows that can act on real-time PRO information.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/70430","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T23:10:08Z","timestamp":1759187408000},"page":"e70430","source":"Crossref","is-referenced-by-count":0,"title":["Association Between a Co-Designed Dashboard and Use of Costly Health Services in Patients With Chronic Kidney Disease and Advanced Cancer: Propensity Score\u2013Adjusted Difference-in-Differences 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