Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Abstract

Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual-and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. MethodsIndividuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR).After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. ResultsIn the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). ConclusionIndividuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.

Palliative care utilization in hospitalized children with cancer

“…28 Less intensive care and fewer invasive procedures are considered corollary metrics of quality end-of-life care. 39,40 Taken together, these results suggest PC involvement is correlated with less intensive medical therapy at the end of life. Due to the cross-sectional nature of this study, we were unable to determine whether PC causes less intensive care and lower inpatient costs per se.…”

“…One other study examined the PC cost for US children with any chronic condition and reported savings of $2458 per day for patients who received PC ( P < .0001) . Less intensive care and fewer invasive procedures are considered corollary metrics of quality end‐of‐life care . Taken together, these results suggest PC involvement is correlated with less intensive medical therapy at the end of life.…”

Measuring health equity in emergency care using routinely collected data: a systematic review

“…(46,47) One used this indicator to analyse the rate of hospital admissions through the ED in the year following a diagnosis of breast, colorectal, non-small cell lung or pancreatic cancer. (48) Overall, indicators of access to outpatient care and particularly ED visits and emergency admission and ACSCs ED visits/ACSCs emergency admissions were the most frequent indicators used across studies.…”

“…Insurance coverage as a relevant SEDH was approached in diverse ways amongst the 16 articles that used it including comparing outcomes between uninsured and insured individuals, (24,30) between publicly and privately insured individuals, (33,(38)(39)(40)46,49) or between uninsured, publicly and privately insured individuals. (23,25,35,(41)(42)(43)47,48) Present in more than half (55%) of the studies analysed, it is the most widely used SEDH in analyses of health care equity identi ed in this review. (It re ects the ability to pay in Levesque's framework).…”

“…"Carstairs Index"[2],(31,36) "Index of Marginalization area"[3],(27) "INSPQ deprivation Index"[4],(28,34) "area-based socioeconomic status quintile index"[5],(48) and "CT/10"[6] (26) These various tools take into account information about income, education, access to services, community safety, and physical environment. These indices are not assessed at the individual-level, but are instead area-based indices at the level of neighbourhoods, communities or health care regions.…”