Value of Distress Screening for Healthcare Utilization and Spending

February 28, 2023
A young girl holds a yellow flower between the palms of her hands

Mental health screening may reduce the use of higher cost emergency care services by promoting a shift to lower cost nonemergent and preventive care.

Cancer screening is a routine practice in healthcare, and its value is widely recognized. We know that screening helps save lives by detecting many common cancers early, when they can be easier to treat. This, in turn, can lead to improved clinical outcomes for patients and reduced healthcare costs.

The same logic applies to distress screening: Detecting early signs of emotional or mental distress can foster better patient outcomes and lower healthcare utilization and spending. 

The Role of Cancer Distress Screening

Distress screening identifies people at risk for mental health concerns like anxiety or depression. For cancer patients, it is especially critical to screen for these concerns. People facing a cancer diagnosis are at higher risk than the general population for both anxiety and depression. Left unaddressed, their distress can lead to poor clinical outcomes, including reduced quality of life.

In September 2022, the U.S. Preventive Services Task Force issued a draft recommendation that adults under age 65 in the general population be screened for anxiety. The screening recommendation would apply to any adults who do not have a diagnosed mental health condition. In 2016, the USPSTF issued a separate recommendation that adults in the general population be screened for depression.

By detecting signs of anxiety or depression early, distress screening can help ensure that cancer patients receive critical mental healthcare support and treatment before their distress potentially advances to a crisis.

In turn, distress screening can play a role in lowering healthcare utilization and associated costs, since people experiencing crisis may require emergency care and, in some cases, inpatient care. For example, those who experience depression or anxiety may not have the desire or energy to fill their prescriptions, or they may take their medications inconsistently. Distress screening can help patients get needed mental health support that encourages adherence to prescribed medications.

To help cancer patients receive prompt supportive care services based on their unique needs, Cancer Support Community’s research team developed CancerSupportSource® (CSS), a multidimensional psychosocial distress screening, referral, and follow-up program for cancer patients and survivors. 

By pinpointing specific areas of distress, the CancerSupportSource program promptly connects patients with resources that address their critical mental health needs.

Hosted on a digital platform, the program is designed to identify cancer patients experiencing distress and who are at risk for clinically significant levels of anxiety and depression. The screening portion asks patients to rate concerns related to:

  • Emotional well-being
  • Symptom burden and impact
  • Body image and healthy lifestyle
  • Healthcare team communication
  • Relationships and intimacy
  • Tobacco and substance use

Patients are also asked to indicate if they would like support for any concerns they’ve reported. After the screening is complete, the program provides automated customized referrals for patients within their care settings. 

Uncovering the Value on Healthcare Utilization 

A small retrospective cohort study of 148 breast cancer patients published in the Journal of Psychosocial Oncology Research and Practice assessed the impact of the CSS distress screening program on healthcare utilization and cost at Orlando Health Cancer Institute (OHCI) in Florida.

“We know distress screening of cancer patients is an important part of quality cancer care, but to date, research demonstrating the impact on institutional outcomes, like healthcare utilization rates and costs, has been mixed,” notes Melissa F. Miller, Ph.D., MPH, CSC’s Senior Director of Research and a lead author on the paper. “We sought to link CSS distress screening at a community cancer center to institutional cost savings and optimized service utilization using patient medical records.”

The study focused on patients starting breast cancer treatment at OHCI. Between January 2016 and June 2017, each patient received an automated email invitation to complete the CSS screening.

“CSS has been implemented nationwide throughout Cancer Support Community’s affiliate network, as well as within community-based hospitals, like OHCI,” Dr. Miller notes.

“We used preexisting data to identify exposed (screened) and unexposed (not screened) individuals in the past and traced these patients forward for 2 years to determine the number of emergency department visits and inpatient hospitalizations as well as outpatient, integrative medicine, patient and family counseling, and other allied health services to portray a comprehensive picture of the impact of screening on various types of healthcare utilization.”

The patients were categorized as follows:

  • Patients who completed CSS screening and then used CSC supportive care services at OHCI 
  • Patients who completed CSS screening but did not use CSC supportive care services at OHCI
  • Patients who did not complete CSS screening

The patients who completed CSS screening and used CSC follow-up supportive care services had 50% fewer emergency department visits.

In addition, rates of integrative medicine visits were significantly higher among all patients who completed CSS screening (with or without follow-up support services) compared with patients who did not complete the screening. Rates of counseling visits were also higher among patients who received both screening and follow-up supportive care services.

The findings point to the potential value of distress screening and referral programs. As this study suggests, mental health screening may reduce the use of higher cost emergency care services by promoting a shift to lower cost nonemergent and preventive care.

The sample size was small and there was no significant difference in healthcare costs between the screening groups. However, learnings from the study can be used to inform the research design and key variables needed for larger, prospective studies, including a more diverse sample and the ability to track more costs over a longer period of time.

“With these approaches implemented, it is possible that the reduced and more appropriate utilization we detected may result in a demonstration of reduced healthcare costs within breast cancer and other oncology clinics,” concludes Dr. Miller. “This has important implications for patients, providers, and institutions.”

Leveraging the Data to Address Mental Health Needs

By pinpointing specific areas of distress, the CSS program promptly connects patients with resources that address their critical mental health needs. Used over time, the program platform also builds a storehouse of practical analytics.

Providers can identify, interpret, and utilize patterns in the data — such as frequently reported areas of distress and other informative trends — to make data-driven decisions that more fully support the needs of their unique patient communities.

For patients and providers, it’s a win-win.


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