Examination of Unplanned 30-Day Readmissions to a Comprehensive Cancer Hospital

Saunders, Neil; Nichols, Shawnn D.; Antiporda, Michael; Johnson, Kristen; Walker, Kerri; Nilsson, Rhonda; Graham, Lisa; Old, M.; Klisovic, Rebecca B.; Penza, Sam; Schmidt, Carl

doi:10.1200/jop.2014.001546

Cited by 47 publications

(54 citation statements)

References 14 publications

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“…Polypharmacy is a major predictor of medication-related hospital admissions/readmissions [27,28]. Further, adverse drug events are estimated to be involved in up to 30% of hospital admissions of older adults [36].…”

Section: Characteristicmentioning

confidence: 99%

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Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

Lu‐Yao

Nightingale

Nikita

et al. 2020

Journal of Geriatric Oncology

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Objectives: Polypharmacy (≥5 concurrent medications) is common among older patients with cancer (48%-80%) and associated with increased frailty, morbidity, and mortality. This study examined the relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous (IV) chemotherapy. Materials and Methods: The main data source was the Surveillance, Epidemiology, and End Results-Medicare linked files. Patients (≥65 years) were included if they were diagnosed with prostate (n = 1430), breast (n = 5490), or lung cancer (n = 7309) in 1991-2013 and received IV chemotherapy in 2011-2014. The number of medications during the six-month window pre-IV chemotherapy initiation determined polypharmacy status. Negative binomial models were used to assess the association between polypharmacy and post-chemotherapy inpatient hospitalization. The results were presented as incidence rate ratios. Results: We identified 13,959 patients with prostate, breast, or lung cancer treated with IV chemotherapy. The median number of prescription medications during the six-month window pre-IV chemotherapy initiation was high: ten among patients with prostate cancer, nine among patients with breast cancer, and eleven among patients with lung cancer. Compared to patients taking b5 prescriptions, post-chemotherapy hospitalization rate for patients with prostate cancer was 42%, 75%, and 114% higher among those taking 5-9, 10-14, and 15 + medications, respectively. Patients with breast and lung cancer demonstrated similar patterns. Conclusion: This large population-based study found that polypharmacy during the six-month window pre-IV chemotherapy is highly predictive of post-chemotherapy inpatient hospitalization. Further studies are needed to evaluate whether medication management interventions can reduce post-chemotherapy inpatient hospitalization among older patients with cancer.

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Section: Characteristicmentioning

confidence: 99%

“…Polypharmacy is known to be a major predictor of medicationrelated hospital admissions and hospital readmissions in nononcology populations [27,28]. Among older adults, adverse drug event-associated hospitalizations increased by 175% in men and by 112% in women from 1981 to 2007 [29].…”

Section: Introductionmentioning

confidence: 99%

Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

Lu‐Yao

Nightingale

Nikita

et al. 2020

Journal of Geriatric Oncology

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“…Readmission related to cancer is common and occurs for new diagnoses, symptoms from cancer progression, and complications of procedures [31,32]. We recently identified dependence on IADLs, use of potentially inappropriate medications, and higher risk reasons for index admission to be associated with readmission [33].…”

Section: Discussionmentioning

confidence: 99%

Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer

Jonna

Chiang

Liu

et al. 2016

Support Care Cancer

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Purpose Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization. Methods Through a retrospective cohort study, we reviewed 803 patients who were admitted to Barnes-Jewish Hospital’s Oncology Acute Care of Elders (OACE) unit from 2000–2008. Data collected included Geriatric Assessments from OACE screening questionnaires as well as demographic and medical history data from chart review. The primary end point was time from index admission to death. Cox proportional hazard modeling was performed. Results The median age was 72.5 years old. Geriatric syndromes and functional impairment were common. Half of the patients (50.4%) were dependent in one or more activities of daily living (ADLs) and 74% were dependent in at least one instrumental activity of daily living (IADLs). On multivariate analysis, the following factors were significantly associated with worse overall survival: male gender; a total score <20 on Lawton’s IADL assessment; reason for admission being cardiac, pulmonary, neurologic, inadequate pain control or failure to thrive; cancer type being thoracic, hepatobiliary, or genitourinary; readmission within 30 days; receiving cancer treatment with palliative rather than curative intent; cognitive impairment; and discharge with hospice services. Conclusions In older adults with cancer, certain geriatric parameters are associated with shorter survival after hospitalization. Assessment of functional status, necessity for readmission, and cognitive impairment may provide prognostic information so that oncologists and their patients make more informed, individualized decisions.

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“…Identifying patients associated with higher risk of readmission may be a more cost-effective way to reduce readmissions. Rather than focusing on readmission risk factors for specific medical conditions as others have done [9,10], van Walraven and colleagues [11] developed the “LACE” index, a cross-conditions tool that predicts early death or unplanned readmission after discharge from hospital. The LACE index is composed of data on “ L ength of stay” in the hospital during the current admission, “ A cuity of admission” (acute or not), “ C omorbidity of patient” (measured using the Charlson comorbidity index) [12,13], and “ E mergency department use” in the 6-month period before the current admission.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Performance of a Modified LACE Index (LACE-rt) to Predict Unplanned Readmission After Discharge in a Community Teaching Hospital

et al. 2017

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BackgroundThe LACE index was designed to predict early death or unplanned readmission after discharge from hospital to the community. However, implementing the LACE tool in real time in a teaching hospital required practical unavoidable modifications.ObjectiveThe purpose of this study was to validate the implementation of a modified LACE index (LACE-rt) and test its ability to predict readmission risk using data in a hospital setting.MethodsData from the Canadian Institute for Health Information’s Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the hospital electronic medical record for one large community hospital in Toronto, Canada, were used in this study. A total of 3855 admissions from September 2013 to July 2014 were analyzed (N=3855) using descriptive statistics, regression analysis, and receiver operating characteristic analysis. Prospectively collected data from DAD and NACRS were linked to inpatient data.ResultsThe LACE-rt index was a fair test to predict readmission risk (C statistic=.632). A LACE-rt score of 10 is a good threshold to differentiate between patients with low and high readmission risk; the high-risk patients are 2.648 times more likely to be readmitted than those at low risk. The introduction of LACE-rt had no significant impact on readmission reduction.ConclusionsThe LACE-rt is a fair tool for identifying those at risk of readmission. A collaborative cross-sectoral effort that includes those in charge of providing community-based care is needed to reduce readmission rates. An eHealth solution could play a major role in streamlining this collaboration.

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Examination of Unplanned 30-Day Readmissions to a Comprehensive Cancer Hospital

Cited by 47 publications

References 14 publications

Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer

Assessing the Performance of a Modified LACE Index (LACE-rt) to Predict Unplanned Readmission After Discharge in a Community Teaching Hospital

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