Digital Transitional Care Management and Lower Hospital Readmissions in Patients with Cancer: An Allocation Study

Hospital readmissions are common among patients with cancer, yet scalable transitional care strategies remain limited. We conducted a health system-embedded allocation study evaluating whether a digital transitional care management (DTCM) intervention could reduce readmissions among adults discharged from medical oncology services. Between April and September 2024, 1,713 patients were allocated by medical record number parity to DTCM or usual care. The intervention delivered daily electronic symptom assessments and tailored self-management education for 10 days, with moderate or severe symptoms routed to clinical teams. Usual care involved symptom monitoring at the discretion of the treating oncology team. The primary outcome was 30-day readmission, analyzed using cumulative incidence functions with death as a competing event. Thirty-day readmission was lower with DTCM than usual care (30% versus 37%; P = 0.001), as were 90-day readmission (48% versus 54%; P = 0.004) and 30-day emergency department visits without admission (12% versus 17%; P = 0.007). Among intervention participants, 56.6% completed at least one assessment; among those participants, 46.6% reported at least one severe symptom. These findings suggest that a multifaceted DTCM program may reduce post-discharge acute care utilization in patients with cancer.