Factors Associated with Emergency Department Utilization and Admission in Patients with Colorectal Cancer

Weidner, Tiffany K.; Kidwell, John T.; Etzioni, David A.; Sangaralingham, Lindsey R.; Houten, Holly K. Van; Asante, Dennis; Jeffery, Molly Moore; Shah, Nilay D.; Wasif, Nabil

doi:10.1007/s11605-018-3707-z

Cited by 17 publications

(18 citation statements)

References 23 publications

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“…One study in colorectal cancer reported that non-White race was associated with an increase in ED visits and hospitalizations but was not specific to diabetes. 41 Another study in breast cancer reported that Black women were twice as likely to have a hospitalization for any cause after adjusting for confounders. 42 Finally, a study of prostate cancer survivors found that Black and Hispanic men were more likely than NHW men to have an ED visit and less likely to have outpatient visits.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Diabetes-Related Emergency Department Visits and Hospitalizations Among Cancer Survivors

Pinheiro

Soroka

Kern

et al. 2022

JCO Oncology Practice

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PURPOSE: Black and Hispanic individuals with diabetes receive less recommended diabetes care after cancer diagnosis than non-Hispanic Whites (NHW). We sought to determine whether racial/ethnic minorities with diabetes and cancer were at increased risk of diabetes-related emergency department (ED) visits and hospitalizations compared with NHW. METHODS: Using SEER cancer registry data linked to Medicare claims from 2006 to 2014, we included Medicare beneficiaries age 66+ years diagnosed with incident nonmetastatic breast, prostate, or colorectal cancer between 2007 and 2012 who had diabetes. Our primary outcome was any diabetes-related ED visit or hospitalization 366-731 days after cancer diagnosis. Using Fine-Gray subdistribution hazard models, we examined whether risk of ED visits or hospitalizations was higher for racial/ethnic minorities compared with NHW. RESULTS: We included 40,059 beneficiaries with mean age 75.5 years (standard deviation 6.3), 45.6% were women, and 28.9% were non-White. Overall, 825 (2.1%) had an ED visit and 3,324 (8.3%) had a hospitalization related to diabetes in the 366-731 days after cancer diagnosis. Compared with NHW, Black individuals were more likely to have ED visits (2.9% v 2.0%; P < .0001) and hospitalizations (11.7% v 7.8%; P < .0001). Adjusting for potential confounders, Black (adjusted hazard ratio, 1.22; 95% CI, 1.12 to 1.35) individuals had a higher risk of any ED visit or hospitalization compared with NHW. CONCLUSION: Black individuals with diabetes and cancer were at increased risk for diabetes-related ED visits and hospitalizations in the second year after cancer diagnosis compared with NHW even after accounting for confounders.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Diabetes-Related Emergency Department Visits and Hospitalizations Among Cancer Survivors

Pinheiro

Soroka

Kern

et al. 2022

JCO Oncology Practice

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“…On the other hand, it is not possible to determine whether our results are influenced by population variables (race, cultural level, pluripathology, etc.) (26,27) or by organizational variables in the health system where the study was conducted. Considering these limitations, we can conclude that CRC patients whose first contact with the hospital was via the Emergency Department present more advanced stages of the disease and independently predicted poorer survival rates than those with a scheduled visit.…”

Section: Discussionmentioning

confidence: 99%

First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colorectal cancer

et al. 2019

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“…Deidentified administrative claims data from OptumLabs Data Warehouse include medical and pharmacy claims, laboratory results, and enrollment records for >88 million privately insured individuals during the study period. The database contains enrollees with a diverse mixture of ages and ethnicities across all 50 states in the United States 5 and has been used to evaluate health care expenditures and usage in oncology populations 6‐9 . The institutional review board of the University of Alabama at Birmingham approved our study.…”

Section: Methodsmentioning

confidence: 99%

“…The database contains enrollees with a diverse mixture of ages and ethnicities across all 50 states in the United States 5 and has been used to evaluate health care expenditures and usage in oncology populations. [6][7][8][9] The institutional review board of the University of Alabama at Birmingham approved our study.…”

Section: Data Sourcementioning

confidence: 99%

Expenditures among young adults with acute lymphoblastic leukemia by site of care

Wolfson

Bhatia

Ginsberg

et al. 2021

Cancer

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Background Individuals diagnosed with acute lymphoblastic leukemia (ALL) between the ages of 22 and 39 years experience worse outcomes than those diagnosed when they are 21 years old or younger. Treatment at National Cancer Institute–designated Comprehensive Cancer Centers (CCC) mitigates these disparities but may be associated with higher expenditures. Methods Using deidentified administrative claims data (OptumLabs Data Warehouse), the cancer‐related expenditures were examined among patients with ALL diagnosed between 2001 and 2014. Multivariable generalized linear model with log‐link modeled average monthly health‐plan–paid (HPP) expenditures and amount owed by the patient (out‐of‐pocket [OOP]). Cost ratios were used to calculate excess expenditures (CCC vs non‐CCC). Incidence rate ratios (IRRs) compared CCC and non‐CCC monthly visit rates. Models adjusted for sociodemographics, comorbidities, adverse events, and months enrolled. Results Clinical and sociodemographic characteristics were comparable between CCC (n = 160) and non‐CCC (n = 139) patients. Higher monthly outpatient expenditures in CCC patients ($15,792 vs $6404; P < .001) were driven by outpatient hospital HPP expenditures. Monthly visit rates and per visit expenditures for nonchemotherapy visits (IRR = 1.6; P = .001; CCC = $8247, non‐CCC = $1191) drove higher outpatient hospital expenditures among CCCs. Monthly OOP expenditures were higher at CCCs for outpatient care (P = .02). Inpatient HPP expenditures were significantly higher at CCCs ($25,918 vs $13,881; ꞵ = 0.9; P < .001) before accounting for adverse events but were no longer significant after adjusting for adverse events (ꞵ = 0.4; P = .1). Hospitalizations and length of stay were comparable. Conclusions Young adults with ALL at CCCs have higher expenditures, likely reflecting differences in facility structure, billing practices, and comprehensive patient care. It would be reasonable to consider CCCs comparable to the oncology care model and incentivize the framework to achieve superior outcomes and long‐term cost savings. Lay Summary Health care expenditures in young adults (aged 22‐39 years) with acute lymphoblastic leukemia (ALL) are higher among patients at National Cancer Institute‐designated Comprehensive Cancer Centers (CCC) than those at non‐CCCs. The CCC/non‐CCC differences are significant among outpatient expenditures, which are driven by higher rates of outpatient hospital visits and outpatient hospital expenditures per visit at CCCs. Higher expenditures and visit rates of outpatient hospital visits among CCCs may also reflect how facility structure and billing patterns influence spending or comprehensive care. Young adults at CCCs face higher inpatient HPP expenditures; these are driven by serious adverse events.

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Factors Associated with Emergency Department Utilization and Admission in Patients with Colorectal Cancer

Cited by 17 publications

References 23 publications

Racial Disparities in Diabetes-Related Emergency Department Visits and Hospitalizations Among Cancer Survivors

Racial Disparities in Diabetes-Related Emergency Department Visits and Hospitalizations Among Cancer Survivors

First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colorectal cancer

Expenditures among young adults with acute lymphoblastic leukemia by site of care

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