Model for the Cost-Efficient Delivery of Continuous Quality Cancer Care: A Hospital and Private-Practice Collaboration

Coyle, Yvonne M.; Miller, Alan M.; Paulson, R Steven

doi:10.1080/08998280.2013.11928928

Cited by 14 publications

(35 citation statements)

References 11 publications

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“…Furthermore, providers and policymakers may be particularly interested in populations with high ED use because reducing potentially preventable ED use is often cited as one of the goals of care coordination and alternative health care model programs. 2,28,29 The number of newly diagnosed cancer patients with multiple ED visits is also substantial. We found 15% of recently diagnosed cancer patients had two or more ED visits within 180 days of diagnosis, compared with 8% of the general US population having two or more ED visits in all of 2010.…”

Section: Discussionmentioning

confidence: 99%

Emergency department use by recently diagnosed cancer patients in California

Lash¹,

Bell²,

Bold³

et al. 2017

J Community Support Oncol

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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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Section: Discussionmentioning

confidence: 99%

Emergency department use by recently diagnosed cancer patients in California

Lash¹,

Bell²,

Bold³

et al. 2017

J Community Support Oncol

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show abstract

“…4,5 Several cancer centers have created an urgent care clinic (UCC) for their patients with cancer aimed at reducing ED visits. [6][7][8][9][10] However, it is not clear whether UCCs actually reduce the volume of ED visits or whether they serve as a conduit to ED referral.…”

Section: Introductionmentioning

confidence: 99%

Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits

Hong

Froehlich

Hobbs³

et al. 2019

JOP

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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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“…6–2,15,16 In light of these policy changes, some medical specialties, including oncology, are expanding care models to include care coordination, with the aim of reducing unnecessary health service use. 4,15,17,18 In fact, the Centers for Medicare & Medicaid Services has recently announced the development of a new payment model designed specifically for oncology practices. 19,20 This model is anticipated to introduce overall cost savings, in part through improved care coordination, resulting in fewer avoidable ED visits.…”

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confidence: 99%

A Systematic Review of Emergency Department Use Among Cancer Patients

et al. 2017

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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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Model for the Cost-Efficient Delivery of Continuous Quality Cancer Care: A Hospital and Private-Practice Collaboration

Cited by 14 publications

References 11 publications

Emergency department use by recently diagnosed cancer patients in California

Emergency department use by recently diagnosed cancer patients in California

Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits

A Systematic Review of Emergency Department Use Among Cancer Patients

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