Potentially Avoidable Hospital Readmissions in Patients With Advanced Cancer

Abstract

PURPOSE: Patients with cancer often prefer to avoid time in the hospital; however, data are lacking on the prevalence and predictors of potentially avoidable readmissions (PARs) among those with advanced cancer. METHODS: We enrolled patients with advanced cancer from September 2, 2014, to November 21, 2014, who had an unplanned hospitalization and assessed their patient-reported symptom burden (Edmonton Symptom Assessment System) at the time of admission. For 1 year after enrollment, we reviewed patients’ health records to determine the primary reason for every hospital readmission and we classified readmissions as PARs using adapted Graham’s criteria. We examined predictors of PARs using nonlinear mixed-effects models with binomial distribution. RESULTS: We enrolled 200 (86.2%) of 232 patients who were approached. For these 200 patients, we reviewed 277 total hospital readmissions and identified 108 (39.0%) of these as PARs. The most common reasons for PARs were premature discharge from a prior hospitalization (30.6%) and failure of timely follow-up (28.7%). PAR hospitalizations were more likely than non-PAR hospitalizations to experience symptoms as the primary reason for admission (28.7% v 13.0%; P = .001). We found that married patients were less likely to experience PARs (odds ratio, 0.30; 95% CI, 0.15 to 0.57; P < .001) and that those with a higher physical symptom burden were more likely to experience PARs (odds ratio, 1.03; 95% CI, 1.01 to 1.05; P = .012). CONCLUSION: We observed that a substantial proportion of hospital readmissions are potentially avoidable and found that patients’ symptom burdens predict PARs. These findings underscore the need to assess and address the symptom burden of hospitalized patients with advanced cancer in this highly symptomatic population.

Factors associated with healthcare utilisation during first year after cancer diagnose—a population‐based study

“…These are important findings, indicating as in previous studies, that family caregivers perform tasks similar to trained healthcare professionals (Ullgren et al, 2018). Previous research has revealed both heavy burden on family caregivers as well as the challenge of living alone during cancer treatment (Johnson et al, 2019; Lash et al, 2017). One third of the patients in our study were living alone.…”

“…Previous research on cancer healthcare utilisation, mostly focus on end‐of‐life (EoL) care and/or advance stage disease. Unplanned care is an indicator to evaluate healthcare utilisation (Frolich et al, 2008) and may be impacted by diagnosis (Henson et al, 2018), symptom burden (Johnson et al, 2019), co‐morbidity (Kidane et al, 2018) and socioeconomic factors (Henson et al, 2018). Aspects of healthcare utilisation have been used as indicators to demonstrate how well healthcare systems are integrated and structured (BLOCKS: tools & Methodologies to assess integrated care in Europe, 2017; Cortis et al, 2017; Shaw, 2011).…”

“…be impacted by diagnosis (Henson et al, 2018), symptom burden (Johnson et al, 2019), co-morbidity (Kidane et al, 2018) and socioeconomic factors (Henson et al, 2018). Aspects of healthcare utilisation have been used as indicators to demonstrate how well healthcare systems are integrated and structured (BLOCKS: tools & Methodologies to assess integrated care in Europe, 2017;Cortis et al, 2017;Shaw, 2011).…”

Associations of Skeletal Muscle With Symptom Burden and Clinical Outcomes in Hospitalized Patients With Advanced Cancer

“…Upon admission (within 5 days of hospitalization), we obtained informed consent and asked patients to complete a symptom burden questionnaire. 16,17,28,32,33 For this study, we used body composition data obtained from routine clinical CT scans. 34,35 The Dana-Farber/Harvard Cancer Center Institutional Review Board approved this study (body composition analysis was conducted as part of a secondary analysis, and the board waived the need to obtain additional consent to access CT scans).…”

The impact of initial treatment strategy and survival time on quality of end-of-life care among patients with oesophageal and gastric cancer: A population-based cohort study

“…The American Society of Clinical Oncology (ASCO) has suggested a number of quality indicators for EOL care: no more than one emergency department (ED) visit during the last month of life, pain assessment, not dying in the hospital, no intensive care unit admission during the last 30 days of life, enrolment in hospice for a meaningful length of time, and no chemotherapy administered within the last 2 weeks of life [18]. Several studies have shown inadequacies in the quality of EOL care, characterized by late delivery [19], unplanned hospitalization [20][21][22], and aggressive care such as non-beneficial medical treatments or interventions [23]; however, this differs substantially across cancer diagnoses [24]. One study indicated that surgically-treated patients receive significantly less hospice care in the last year of life compared with medically-treated patients [25], while another demonstrated that patients undergoing resection are less likely to enrol in hospice early and more likely to be admitted to an acute-care hospital in the last month of life [26].…”