Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

Abstract

ImportanceAn initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented.ObjectiveTo explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US.Design, Setting, and ParticipantsThis cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends among 35 510 014 ED visits by adult patients (aged ≥18 years) with cancer were calculated.Main Outcomes and MeasuresThe primary outcome was potentially preventable ED visits, and secondary outcomes were unplanned hospitalizations and the immediacy of the ED visits. Potentially preventable ED visits were identified using the Centers for Medicare & Medicaid Services definition. The Emergency Severity Index, a triage algorithm that ranks patients based on the urgency of their health care condition, was used to measure the immediacy of ED visits (immediate [most urgent], emergent, urgent, less urgent, and nonurgent), with the categories of immediate and emergent classified as high acuity. The Wilcoxon rank sum test was used to calculate trends in ED visits among patients with cancer over time. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization.ResultsAmong 854 911 106 ED visits, 35 510 014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization.Conclusions and RelevanceIn this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

Emergency Department Visits Among Patients With Cancer in the US

“…Although the desire to identify and reduce unnecessary ED visits is a laudable and common effort, it is a far trickier endeavor than it may seem. 3 Notably, the CMS definition used by Tabriz et al 1 includes a range of primary diagnoses (eg, anemia, emesis, and pain), as well as acute life-threatening conditions (eg, pneumonia and sepsis).…”

“…Tabriz and colleagues 1 estimated the number of ED visits by patients with cancer that are potentially preventable, using a Centers for Medicare & Medicaid Services (CMS) quality measure definition. 1,2 Using the 2012 to 2019 National Hospital Ambulatory Medical Care Survey, they estimated that ED visits by patients with cancer increased from 3 734 101 in 2012 to 6 240 650 in 2019 (5.4% of all ED visits that year) and that more than one-half of these visits were potentially preventable.As noted by Tabriz et al, 1 the ED is far from the optimal setting for patients with cancer, putting them at risk for complications, including nosocomial infections, and potentially costing more than other settings, as we will discuss later in this article. Although the desire to identify and reduce unnecessary ED visits is a laudable and common effort, it is a far trickier endeavor than it may seem.…”

“…Tabriz and colleagues 1 estimated the number of ED visits by patients with cancer that are potentially preventable, using a Centers for Medicare & Medicaid Services (CMS) quality measure definition. 1,2 Using the 2012 to 2019 National Hospital Ambulatory Medical Care Survey, they estimated that ED visits by patients with cancer increased from 3 734 101 in 2012 to 6 240 650 in 2019 (5.4% of all ED visits that year) and that more than one-half of these visits were potentially preventable.…”

“…Also unsurprisingly, because a majority of patients with advanced cancer will report pain, 6 Tabriz and colleagues 1 found the most common reason for ED visits for patients with cancer is pain, accounting for 36.9% of ED visits; however, only 23.5% of those patients were admitted. Patients at risk for having uncontrolled pain could potentially be identified earlier, and steps could be taken that would address their pain and help prevent acute care visits.…”

“…Although many of these issues can be and are managed in the outpatient setting, patients with cancer sometimes seek care in the emergency department (ED), often at the direction of their care team, and many are subsequently hospitalized. Tabriz and colleagues estimated the number of ED visits by patients with cancer that are potentially preventable, using a Centers for Medicare & Medicaid Services (CMS) quality measure definition . Using the 2012 to 2019 National Hospital Ambulatory Medical Care Survey, they estimated that ED visits by patients with cancer increased from 3 734 101 in 2012 to 6 240 650 in 2019 (5.4% of all ED visits that year) and that more than one-half of these visits were potentially preventable.…”