Improving cancer patient emergency room utilization: A New Jersey state assessment |
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| Affiliation: | 1. Department of Surgery, Division of Surgical Oncology, Rutgers University– New Jersey Medical School, Newark, NJ, United States;2. Department of Surgery – Rutgers University – New Jersey Medical School, Newark, NJ, United States;3. Department of Radiation Oncology − Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States;4. Department of Radiation Oncology – Rutgers University – New Jersey Medical School, Newark, NJ, United States;5. Department of Medicine – Rutgers University – New Jersey Medical School, Newark, NJ, United States;6. Rutgers Institute for Data Science, Learning & Applications, and Department of Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, United States;7. Graduate School of Biomedical Science, Rutgers University, Newark, NJ, United States;8. Department of Statistics and Biostatistics, Rutgers University, Newark, NJ, United States;1. Department of Oncology, Queen’s University, Kingston, Canada;2. Department of Surgery, Queen’s University, Kingston, Canada;3. Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Canada;1. Hawaii Tumor Registry, University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813, USA;2. Guam Cancer Registry, Cancer Research Center of Guam, University of Guam, House #7, Dean Circle, UOG Station, Mangilao, Guam 96923, USA;3. Guam Department of Public Health and Social Services, Office of Epidemiology and Research, Mangilao, Guam 96923, USA;1. Registre des cancers du Bas-Rhin, U1113, FMTS, Université de Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France;2. Service de santé publique, Hôpitaux Universitaires de Strasbourg, 1 place de l’hôpital, 67091 Strasbourg, France;3. Registre des cancers de la Manche, Centre Hospitalier Public du Cotentin, 46 rue du Val de Saire, 50102 Cherbourg-Octeville, France;4. Registre des tumeurs de l''Hérault, Centre de Recherche, 208 rue des Apothicaires, 34298 Montpellier, France;5. Registre général des tumeurs du Calvados, Cancers & Préventions – U1086 Inserm, Centre François Baclesse, Avenue du Général Harris BP 5026, 14076 Caen, France;6. Registre des tumeurs du Doubs et du Territoire de Belfort, EA3181, Centre Hospitalier Régional Universitaire, 25030 Besançon, France;7. Registre des cancers du Tarn, 1, rue Lavazière, BP 37, 81001 Albi cedex, France;8. Institut Claudius Regaud, Centre régional de lutte contre le cancer, IUCT-O, Registre des cancers du Tarn, 31059 Toulouse, France;9. Registre des hémopathies malignes de Basse-Normandie, Unité Fonctionnelle Hospitalo-Universitaire n°0350, Centre Hospitalier Universitaire, Avenue de la Côte de Nacre, 14033 Caen, France;10. Registre des cancers de l’Isère, CHU de Grenoble, Pavillon E BP 217, 38043 Grenoble 9, France;11. Registre du cancer de la Somme, Service Épidémiologie Hygiène et Santé Publique, CHU Nord, 80054 Amiens, France;12. Service d’épidémiologie et de biostatistique, Centre Paul Strauss, 3 rue de la Porte de l’hôpital, 67065 Strasbourg, France;1. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark;2. Center for Observational Research, Amgen, Inc, 1120 Veterans Boulevard, South San Francisco, CA 94080, USA;3. Department of Urology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark;4. Department of Urology, Aalborg University Hospital, Reberbansgade 15, 9100 Aalborg, Denmark;5. Center for Observational Research, Amgen, Inc, One Amgen Center Drive, Thousand Oaks, CA 91320, USA;1. Departments of Clinical Pharmacy and of Medicine, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94143-0613, USA;2. Department of Clinical Pharmacy, University of California, 3333 California Street, San Francisco, CA, 94143-0613, USA;3. San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6012, USA |
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| Abstract: | IntroductionDue to its increasing incidence and its major contribution to healthcare costs, cancer is a major public health problem in the United States. The impact across different services is not well documented and utilization of emergency departments (ED) by cancer patients is not well characterized. The aim of our study was to identify factors that can be addressed to improve the appropriate delivery of quality cancer care thereby reducing ED utilization, decreasing hospitalizations and reducing the related healthcare costs.MethodsThe New Jersey State Inpatient and Emergency Department Databases were used to identify the primary outcome variables; patient disposition and readmission rates. The independent variables were demographics, payer and clinical characteristics. Multivariable unconditional logistic regression models using clinical and demographic data were used to predict hospital admission or emergency department return.ResultsA total of 37,080 emergency department visits were cancer related with the most common diagnosis attributed to lung cancer (30.0%) and the most common presentation was pain. The disposition of patients who visit the ED due to cancer related issues is significantly affected by the factors of race (African American OR = 0.6, p value = 0.02 and Hispanic OR = 0.5, p value = 0.02, respectively), age aged 65 to 75 years (SNF/ICF OR 2.35, p value = 0.00 and Home Healthcare Service OR 5.15, p value = 0.01, respectively), number of diagnoses (OR 1.26, p value = 0.00), insurance payer (SNF/ICF OR 2.2, p value = 0.02 and Home Healthcare Services OR 2.85, p value = 0.07, respectively) and type of cancer (breast OR 0.54, p value = 0.01, prostate OR 0.56, p value = 0.01, uterine OR 0.37, p value = 0.02, and other OR 0.62, p value = 0.05, respectively). In addition, comorbidities increased the likelihood of death, being transferred to SNF/ICF, or utilization of home healthcare services (OR 1.6, p value = 0.00, OR 1.18, p value = 0.00, and OR 1.16, p value = 0.04, respectively). Readmission is significantly affected by race (American Americans OR 0.41, standard error 0.08, p value = 0.001 and Hispanics OR 0.29, standard error 0.11, p value = 0.01, respectively), income (Quartile 2 OR 0.98, standard error 0.14, p value 0.01, Quartile 3 OR 1.07, standard error 0.13, p value 0.01, and Quartile 4 OR 0.88, standard error 0.12, p value 0.01, respectively), and type of cancer (prostate OR 0.25, standard error 0.09, p value = 0.001).ConclusionWeb based symptom questionnaires, patient navigators, end of life nursing and clinical cancer pathways can identify, guide and prompt early initiation of treat before progression of symptoms in cancer patients most likely to visit the ED. Thus, improving cancer patient satisfaction, outcomes and reduce health care costs. |
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| Keywords: | Cancer Emergency room Utilization |
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