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Galloway K, Lambert P, Bow EJ, Czaykowski P, Fatoye T, Goldenberg B, Kristjanson M, Singh H, Bucher O, Decker K. Evaluation of the Impact of the Urgent Cancer Care Clinic on Emergency Department Visits, Primary Care Clinician Visits, and Hospitalizations in Winnipeg, Manitoba. Curr Oncol 2023; 30:6771-6785. [PMID: 37504356 PMCID: PMC10378500 DOI: 10.3390/curroncol30070496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
The urgent cancer care (UCC) clinic at CancerCare Manitoba (CCMB) opened in 2013 to provide care to individuals diagnosed with cancer and serious blood disorders experiencing complications from the underlying disorder or its treatment. This study examined the impact of the UCC clinic on other health care utilization in Winnipeg, Manitoba, Canada. An interrupted time series study design was used to compare the rates of emergency department (ED) visits, primary care clinician (PCC) visits, and hospitalizations from 1 January 2010 to 31 December 2015. Rates of ED visits were also stratified by ED location, severity, and cancer type. We found a 6% (95% CI 1.00-1.13, p-value = 0.0389) increase in PCC visits, a 7% (95% CI 0.99-1.15, p-value = 0.0737) increase in hospitalizations, a 4% (95% CI 0.86-1.08, p-value = 0.5053) decrease in the rate of ED visits, and a 3% (95% CI 0.92-1.17, p-value = 0.5778) increase in the rate of ED visits during the UCC clinic hours after the UCC clinic opened. The implementation of the UCC clinic had minimal impact on health care utilization. Future work should examine the impact of the UCC clinic on other aspects of healthcare utilization (e.g., number of tests ordered and time spent waiting in CCMB's main clinics) and patient quality of life and patient and health care provider experience.
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Affiliation(s)
- Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
| | - Pascal Lambert
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Eric J Bow
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, MB R3E 0J9, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Tunji Fatoye
- Department of Primary Care Oncology, Cancer Care Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
| | - Benjamin Goldenberg
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Mark Kristjanson
- Department of Primary Care Oncology, Cancer Care Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Harminder Singh
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Kathleen Decker
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
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Christodoulou I, Ukert B, Vavuranakis MA, Kum HC, Giannouchos TV. Adult Cancer-Related Emergency Department Utilization: An Analysis of Trends and Outcomes From Emergency Departments in Maryland and New York. JCO Oncol Pract 2023; 19:e683-e695. [PMID: 36827627 DOI: 10.1200/op.22.00525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To explore emergency department (ED) visits by adults with cancer and to estimate associations between inpatient admissions through the ED and mortality with sociodemographic and clinical factors within this cohort. METHODS We conducted a retrospective, pooled, cross-sectional analysis of the Healthcare Cost and Utilization State Emergency Department Databases and State Inpatient Databases for Maryland and New York from January 2013 to December 2017. We examined inpatient admissions through the ED and mortality using frequencies. Among patients with cancer, multivariable regressions were used to estimate sociodemographic and clinical factors associated with inpatient admissions and outpatient ED and inpatient mortality overall. RESULTS Among 22.7 million adult ED users, 1.3 million (5.7%) had at least one cancer-related diagnosis. ED visit rates per 100,000 population increased annually throughout the study period for patients with cancer and were 9.9% higher in 2017 compared with 2013 (2013: 303.5; 2017: 333.6). Having at least one inpatient admission (68.7% v 20.5%; P < .001) and inpatient or ED mortality (6.5% v 1.0%; P < .001) were higher among ED users with cancer compared with those without. Among patients with cancer, being uninsured (adjusted odds ratio, 0.52; 95% CI, 0.44 to 0.62) compared with having Medicare coverage and non-Hispanic Black (adjusted odds ratio, 0.86; 95% CI, 0.80 to 0.92) compared with non-Hispanic White were associated with decreased odds of inpatient admissions. In contrast, patients with cancer without health insurance, non-Hispanic Black patients, and residents of nonlarge metropolitan areas and of areas with lower household incomes had increased odds of mortality. CONCLUSION High inpatient admissions through the ED and mortality among adult patients with cancer, coupled with an increase in cancer-related ED visit rates and observed disparities in outcomes, highlight the need to improve access to oncologic services to contain ED use and improve care for patients with cancer.
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Affiliation(s)
- Ilias Christodoulou
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.,The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin Ukert
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX
| | | | - Hye-Chung Kum
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX
| | - Theodoros V Giannouchos
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Ferrara L, Otto M, Aapro M, Albreht T, Jonsson B, Oberst S, Oliver K, Pisani E, Presti P, Rubio IT, Terkola R, Tarricone R. How to improve efficiency in cancer care: dimensions, methods, and areas of evaluation. J Cancer Policy 2022; 34:100355. [PMID: 36007873 DOI: 10.1016/j.jcpo.2022.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
Efficiency in healthcare is crucial since available resources are scarce, and the opportunity cost of an inefficient allocation is measured in health outcomes foregone. This is particularly relevant for cancer. The aim of this paper was to gain a comprehensive overview of how efficiency in cancer care is defined, and what the indicators, different methods, perspectives, and areas of evaluation are, to provide recommendations on the areas and dimensions where efficiency can be improved. METHODS: A comprehensive scoping literature review was performed searching four databases. Studies published between 2000-2021 were included if they described experiences and cases of efficiency in cancer care or methods to evaluate efficiency. The results of the literature review were then discussed during two rounds of online consultation with a panel of 15 external experts invited to provide their insights and comments to deliberate policy recommendations. RESULTS: 46 papers met the inclusion criteria. Based on the papers retrieved we have identified six areas for achieving efficiency gains throughout the entire care pathway and, for each area of efficiency, we have categorized the methods and outcome used to measure efficiency gain CONCLUSION: This is the first attempt to systematize a scattered body of literature on how to improve efficiency in cancer care and identify key areas to improve it. Based on the findings of the literature review and on the opinion of the experts involved in the consultation, we propose seven recommendations that are intended to improve efficiency in cancer care throughout the care pathway.
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Affiliation(s)
- Lucia Ferrara
- Cergas SDA Bocconi School of management, via Sarfatti, 11 - 20136 Milano (Italy).
| | - Monica Otto
- Cergas SDA Bocconi School of management, via Sarfatti, 11 - 20136 Milano (Italy).
| | - Matti Aapro
- Genolier Hospital Genolier Cancer Center, SPCC - Sharing Progress in Cancer Care, Route du Muids 3, 1272 Genolier (Switzerland).
| | - Tit Albreht
- Centre for Health Care, National Institute of Public Health, Ljubljana, (Slovenia) iPAAC - Innovative Partnership for Action against Cancer.
| | - Bengt Jonsson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden.
| | - Simon Oberst
- OECI - Organisation of European Cancer Institutes, rue d'Egmont 11, B-1000 Brussels (Belgium).
| | - Kathy Oliver
- IBTA - International Brain Tumor Alliance, Tadworth, Surrey (United Kingdom).
| | - Eduardo Pisani
- All.Can - All.Can International asbl, Brussels, rue du Luxemburg 22-24, BE-1000 Brussels (Belgium).
| | - Pietro Presti
- SPCC - Sharing Progress in Cancer Care, Piazza Indipendenza 2, 6500 Bellinzona (Switzerland).
| | - Isabel T Rubio
- Clinica Universidad de Navarra, Madrid, ESSO - European Society of Surgical Oncology, Av. de Pío XII, 36, 31008 Pamplona, Navarra (Spain).
| | - Robert Terkola
- University Medical Center Groningen; University of Florida -College of Pharmacy; ESOP - European Society of oncology pharmacy.
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Gould Rothberg BE, Canavan ME, Mun S, Sedghi T, Carafeno T, Raucci M, Dest V, Sinanis N, Gross CP, Adelson KB. Impact of a Dedicated Cancer Urgent Care Center on Acute Care Utilization. JCO Oncol Pract 2021; 18:e129-e136. [PMID: 34383579 DOI: 10.1200/op.21.00183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Acute care imposes a significant burden on patients and cancer care costs. We examined whether an advanced practice provider-driven, cancer-specific urgent care center embedded within a large tertiary academic center decreased acute care use among oncology patients on active therapy. MATERIALS AND METHODS We conducted a quasi-experimental study anchored around the Oncology Extended Care Clinic (OECC) opening date. We evaluated two parallel 4-month periods: a post-OECC period that followed a 5-month run-in phase, and the identical calendar period 1 year earlier. Our primary outcomes included all emergency department (ED) presentations and hospital admissions during the 3-month window following the index provider visit. We used Poisson models to calculate absolute pre-OECC v post-OECC rate differences. RESULTS Our cohort included 2,095 patients in the pre-OECC period and 2,188 in the post-OECC period. We identified 32.6 ED visits/100 patients and 41.2 hospitalizations/100 patients in the pre-OECC period, versus 28.2 ED visits/100 patients and 26.1 hospitalizations/100 patients post-OECC. After adjusting for age, sex, race and ethnicity, and practice location, we observed a significant decrease of 4.6 ED visits/100 patients during the post-OECC period (95% CI, -8.92/100 to -0.28/100; P = .04) compared with the pre-OECC period. There was no significant association between the OECC opening and hospitalization rate (rate difference: -3.29 admissions/100 patients; 95% CI, -8.24/100 to 1.67/100; P = .19). CONCLUSION Establishing a cancer-specific urgent care center was significantly associated with a modest decrease in emergency room utilization but not with hospitalization rate. Barriers included clinic capacity, patient awareness, and physician comfort with advanced practice provider autonomy. Optimizing workflow and standardizing clinical pathways can create benchmarks useful for value-based payments.
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Affiliation(s)
| | - Maureen E Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Sophia Mun
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT
| | - Tannaz Sedghi
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT
| | - Tracy Carafeno
- Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT
| | - Maureen Raucci
- Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT
| | - Vanna Dest
- Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT
| | - Naralys Sinanis
- Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kerin B Adelson
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT.,Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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Predictors of Urgent Cancer Care Clinic and Emergency Department Visits for Individuals Diagnosed with Cancer. CURRENT ONCOLOGY (TORONTO, ONT.) 2021; 28:1773-1789. [PMID: 34066855 PMCID: PMC8161790 DOI: 10.3390/curroncol28030165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 01/30/2023]
Abstract
In 2013, CancerCare Manitoba (CCMB) launched an urgent cancer care clinic (UCC) to meet the needs of individuals diagnosed with cancer experiencing acute complications of cancer or its treatment. This retrospective cohort study compared the characteristics of individuals diagnosed with cancer that visited the UCC to those who visited an emergency department (ED) and determined predictors of use. Multivariable logistic mixed models were run to predict an individual’s likelihood of visiting the UCC or an ED. Scaled Brier scores were calculated to determine how greatly each predictor impacted UCC or ED use. We found that UCC visits increased up to 4 months after eligibility to visit and then decreased. ED visits were highest immediately after eligibility and then decreased. The median number of hours between triage and discharge was 2 h for UCC visits and 9 h for ED visits. Chemotherapy had the strongest association with UCC visits, whereas ED visits prior to diagnosis had the strongest association with ED visits. Variables related to socioeconomic status were less strongly associated with UCC or ED visits. Future studies would be beneficial to planning service delivery and improving clinical outcomes and patient satisfaction.
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Coyle YM, Ogola GO, MacLachlan CR, Hinshelwood MM, Fleming NS. Acute care model that reduces oncology-related unplanned hospitalizations to promote quality of care and reduce cost. J Cancer Policy 2019. [DOI: 10.1016/j.jcpo.2019.100193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen H, Walabyeki J, Johnson M, Boland E, Seymour J, Macleod U. An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: Qualitative modelling of secondary-care health professionals' experiences and views. PLoS One 2019; 14:e0216430. [PMID: 31048875 PMCID: PMC6497383 DOI: 10.1371/journal.pone.0216430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/20/2019] [Indexed: 11/18/2022] Open
Abstract
The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We conducted semi-structured interviews with 42 senior clinicians (20 doctors, 22 nurses) with diverse expertise and experience in caring for acutely ill cancer patients in the secondary care setting. Data analysis included thematic analysis and purposive text analysis to develop Causal Loop Diagrams. Our Causal Loop Diagrams represent an integrated understanding of the complex factors (13) influencing emergency hospital use in cancer patients. Eight factors formed five reinforcing feedback loops and therefore were high-leverage influences: Ability of patients and carers to self-care and cope; Effective and timely management of ambulatory care sensitive conditions by primary and community care; Sufficient and effective social care for patients and carers; Avoidable emergency hospital use; Bed capacity; Patients accessing timely appropriate specialist inpatient or ambulatory care; Prompt and effective management and prevention of acute episode; Timely and safe discharge with appropriate support. The loops show that reduction of avoidable hospital use helps relieve hospital bed pressure; improved bed capacity then has a decisive, positive influence on patient pathway and thus outcome and experience in the hospital; in turn, better in-hospital care and discharge help patients and carers self-care and cope better back home with better support from community-based health and social care services, which then reduces their future emergency hospital use. To optimise acute and emergency cancer care, it is also essential that patients, carers and other clinicians caring for cancer patients have prompt access to senior cancer specialists for advice, assessment, clinical decision and other support. The findings provide a useful framework and focus for service planners aiming to optimise care.
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Affiliation(s)
- Hong Chen
- Academy of Primary Care, Institute of Clinical and Applied Heath Research, Hull York Medical School, University of Hull, Hull, United Kingdom
- * E-mail:
| | - Julie Walabyeki
- Academy of Primary Care, Institute of Clinical and Applied Heath Research, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Institute of Clinical and Applied Heath Research, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Elaine Boland
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
| | - Julie Seymour
- Academy of Primary Care, Institute of Clinical and Applied Heath Research, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Una Macleod
- Academy of Primary Care, Institute of Clinical and Applied Heath Research, Hull York Medical School, University of Hull, Hull, United Kingdom
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Hong AS, Froehlich T, Clayton Hobbs S, Lee SJC, Halm EA. Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits. J Oncol Pract 2019; 15:e501-e509. [PMID: 31021677 DOI: 10.1200/jop.18.00743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer? PATIENTS AND METHODS We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group. Our primary outcome was emergency department visits within 180 days after a cancer diagnosis, compiled as adjusted monthly rates of emergency department visits per 1,000 patient-months. We analyzed subsequent hospitalizations as a secondary outcome. RESULTS The rate of weekday emergency department visits was increasing at a rate of 0.43 visits (95% CI, 0.29 to 0.57 visits) per month before May 2012, then fell in half to a rate of 0.19 visits (95% CI, 0.11 to 0.28 visits) per month (P = .007) after the urgent care clinic was established. In contrast, the weekend visit rate was growing at a rate of 0.08 visits (95% CI, -0.03 to 0.19 visits) per month before May 2012 and 0.05 (95% CI, -0.02 to 0.13 visits; P = .533) afterward. By the end of 2016, there were 15.3 fewer monthly weekday emergency department visits than expected (P = .005). Trends in weekday hospitalizations were not significantly changed. CONCLUSION Although only one in eight emergency department-visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.
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Affiliation(s)
- Arthur S Hong
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas Froehlich
- 1 University of Texas Southwestern Medical Center, Dallas, TX.,2 Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | | | - Simon J Craddock Lee
- 1 University of Texas Southwestern Medical Center, Dallas, TX.,2 Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Ethan A Halm
- 1 University of Texas Southwestern Medical Center, Dallas, TX.,2 Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
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Hong AS, Sadeghi N, Harvey V, Lee SC, Halm EA. Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System. J Oncol Pract 2019; 15:e490-e500. [PMID: 30964735 DOI: 10.1200/jop.18.00614] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. PATIENTS AND METHODS This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. RESULTS The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). CONCLUSION ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.
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Affiliation(s)
- Arthur S Hong
- 1 University of Texas Southwestern Medical Center, Dallas, TX
| | - Navid Sadeghi
- 1 University of Texas Southwestern Medical Center, Dallas, TX.,2 Parkland Health & Hospital System, Dallas, TX
| | | | - Simon Craddock Lee
- 1 University of Texas Southwestern Medical Center, Dallas, TX.,3 Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
| | - Ethan A Halm
- 1 University of Texas Southwestern Medical Center, Dallas, TX.,3 Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
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Abstract
BACKGROUND Recent reports call for reductions in costly and potentially avoidable services such as emergency department (ED) visits. Providing high-quality and safe care for oncology patients remains challenging for ED providers given the diversity of patients seeking care and the unpredictable clinical environment. While ED use by oncology patients is appropriate for acute health concerns, some ED visits may be preventable with well-coordinated care and adequate symptom management. OBJECTIVE The aim of this study was to summarize available evidence regarding the incidence, predictors of, and reasons for ED visits among oncology patients. METHODS Keyword/MeSH term searches were conducted using 4 online databases. Inclusion criteria were publication date between April 1, 2003, and December 5, 2014; sample size of 50 or more; and report of the incidence or predictors of ED use among oncology patients. RESULTS The 15 studies that met criteria varied in study aim, design, and time frames for calculating ED utilization rates. The incidence of ED visits among oncology patients ranged from 1% to 83%. The 30-day standardized visit rate incidence ranged from 1% to 12%. Collectively, the studies lack population-based estimates for all cancers combined. CONCLUSIONS The studies included in this review suggest that rates of ED use among cancer patients exceed those of the general population. However, the extent of ED use by oncology patients and the reasons for ED visits remain understudied. IMPLICATIONS FOR PRACTICE Nurses are involved in the treatment of cancer, patient education, and symptom management. Nurses are well positioned to develop patient-centered treatment and care coordination plans to improve quality of care and reduce ED visits.
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Lash RS, Bell JF, Bold RJ, Joseph JG, Cress RD, Wun T, Brunson AM, Romano PS. Emergency department use by recently diagnosed cancer patients in California. THE JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY 2017; 15:95-102. [PMID: 33215043 PMCID: PMC7673305 DOI: 10.12788/jcso.0334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Improving the quality of cancer care and reducing preventable health system use are goals of increasing importance to health practitioners and policy makers. Emergency department (ED) visits are often cited as a source of preventable health system use, however, few studies have described the incidence of ED use by recently diagnosed cancer patients in population-based samples, and no study has addressed the full spectrum of cancer types. OBJECTIVE To describe ED use by recently diagnosed cancer patients. METHODS California Office of Statewide Health Planning and Development data and the California Cancer Registry were used to describe ED use in the year after a cancer diagnosis (2009-2010). The incidence of ED use was tabulated by cancer type. Logistic regression and recycled predictions were used to examine ED use adjusting for confounding factors. RESULTS Most ED visits (68%) occurred within 180 days of diagnosis. The incidence of ED use for all cancer types examined was 17% within 30 days, 35% within 180 days and 44% within 365 days of diagnosis. ED use varied by cancer type (5%-39% within 30 days of diagnosis; 14% -62% within 180 days; and 22%-69% within 365 days). Patterns of ED use by cancer type remained similar after accounting for demographic and socioeconomic factors. LIMITATIONS Those common to administrative and registry datasets. Specifically, we were unable to account for ED visits in relation to cancer treatment dates and comorbid conditions. CONCLUSIONS Cancer patients use EDs at higher rates than previously reported, with considerable variability by cancer type. Future research should examine reasons for ED visits by cancer type and identify predictors of ED use, including treatment and comorbid conditions.
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Affiliation(s)
- Rebecca S Lash
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
- Department of Nursing Research and Education, University of California, Los Angeles Health System; Los Angeles
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Richard J Bold
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
- Division of Surgical Oncology, UC Davis School of Medicine, Sacramento
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento
| | - Rosemary D Cress
- Cancer Registry of Greater California, Public Health Institute, Sacramento
- Department of Public Health Sciences, UC Davis School of Medicine, Davis
| | - Ted Wun
- Center for Oncology Hematology, Division of Hematology Oncology, UC Davis School of Medicine, Sacramento
| | - Ann M Brunson
- Center for Oncology Hematology, Division of Hematology Oncology, UC Davis School of Medicine, Sacramento
| | - Patrick S Romano
- Division of General Internal Medicine and Center for Health care Policy and Research, UC Davis School of Medicine, Sacramento
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