From metrics to practice: identifying preventable emergency department visits for patients with cancer

Roy, Mohana; Halbert, Brian; Devlin, Scott M; Chiu, David; Graue, Ryan; Zerillo, Jessica A.

doi:10.1007/s00520-020-05874-3

Cited by 11 publications

(19 citation statements)

References 9 publications

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“…Given that the diagnoses described in Table 3 may be present in over half of cancer-related ED visits but these patients might actually have serious lifethreatening conditions, risk stratification methodologies are needed to better distinguish which ED visits could be safely be prevented [23,39]. More careful clinician chart reviews of ED visits find a lower proportion of potentially preventable visits-10-25% of ED visits in one site [67] and roughly 20% of hospitalizations from another [68]. Finally, all of these determinations are made based on clinician expertise and opinion, yet it remains unclear how even well-equipped health systems and clinical settings could prevent this purportedly preventable care.…”

Section: Preventability Of Ed Visits Among Cancer Patientsmentioning

confidence: 99%

Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

et al. 2022

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Background The global prevalence of cancer is rapidly increasing and will increase the acute care needs of patients with cancer, including emergency department (ED) care. Patients with cancer present to the ED across the cancer care continuum from diagnosis through treatment, survivorship, and end-of-life. This article describes the characteristics and determinants of ED visits, as well as challenges in the effort to define preventable ED visits in this population. Findings The most recent population-based estimates suggest 4% of all ED visits are cancer-related and roughly two thirds of these ED visits result in hospitalization—a 4-fold higher ED hospitalization rate than the general population. Approximately 44% of cancer patients visit the ED within 1 year of diagnosis, and more often have repeat ED visits within a short time frame, though there is substantial variability across cancer types. Similar patterns of cancer-related ED use are observed internationally across a range of different national payment and health system settings. ED use for patients with cancer likely reflects a complex interaction of individual and contextual factors—including provider behavior, health system characteristics, and health policies—that warrants greater attention in the literature. Conclusions Given the amount and complexity of cancer care delivered in the emergency setting, future research is recommended to examine specific symptoms associated with cancer-related ED visits, the contextual determinants of ED use, and definitions of preventable ED use specific to patients with cancer.

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Section: Preventability Of Ed Visits Among Cancer Patientsmentioning

confidence: 99%

Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

et al. 2022

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“…While primary care resource use is reported to be high in the final year of life for those with cancer [14], people with dementia often access less community-based care than their older counterparts, despite greater healthcare needs [41] and are thus high users of emergency departments [42]. Emergency department use is also high in people with cancer [43,44]. In Kedia et al 's US study, people with CCD were the highest users of emergency department services, as might be predicted by a cumulative effect of this comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and general practice resource use of people with comorbid cancer and dementia in England: a retrospective cross-sectional study

et al. 2022

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Background Cancer and dementia are common in older people and management of the conditions as comorbidities can be challenging, yet little is known about the size or characteristics of this group. We aimed to estimate the prevalence, characteristics and general practice resource usage of people living with both conditions in England. Methods Anonymised electronic healthcare records from 391 National Health Service general practices across England using the TPP SystmOne general practice system were obtained from ResearchOne. Data included demographic and clinical characteristics, and general practice healthcare useage (appointments, prescriptions, referrals and secondary care contacts) for people aged 50 and over with a cancer and/or dementia diagnosis consistent with the Quality and Outcomes Framework between 2005 and 2016. Multi-level negative binomial regression was used to analyse the association between having cancer and/or dementia and the number of general practice appointments. Results Data from 162,371 people with cancer and/or dementia were analysed; 3616 (2.2%) people were identified as having comorbid cancer and dementia. Of people with cancer, 3.1% also had dementia, rising to 7.5% (1 in 13 people) in those aged 75 and over. Fewer people with both conditions were female (50.7%) compared to those with dementia alone (65.6%) and those with comorbid cancer and dementia were older than those with cancer alone [mean ages 83 (sd = 7), 69 (sd = 12) respectively]. Those with both conditions were less likely to have lung cancer than those with cancer alone (7.5% vs. 10.3%) but more likely to have prostate cancer (20.9% vs. 15.8%). Additional comorbidities were more prevalent for those with both conditions than those with cancer or dementia alone (68.4% vs. 50.2% vs. 54.0%). In the year following the first record of either condition, people with cancer and dementia had 9% more general practice appointments (IRR:1.09, 95% CI:1.01–1.17) than those with cancer alone and 37% more appointments than those with dementia alone (IRR: 1.37, 95% CI: 1.28–1.47). Conclusions A significant number of people are living with comorbid cancer and dementia in England. This group have additional comorbidity and higher general practice usage than those with cancer/dementia alone. The needs of this group should be considered in future general practice care planning and research.

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“… 13 Another study reported that visits were more likely PPED if patients were assessed by their oncologist the day of presentation. 14 …”

Section: Introductionmentioning

confidence: 99%

Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review

et al. 2023

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Background Patients diagnosed with cancer are frequent users of the emergency department (ED). While many visits are unavoidable, a significant portion may be potentially preventable ED visits (PPEDs). Cancer treatments have greatly advanced, whereby patients may present with unique toxicities from targeted therapies and are often living longer with advanced disease. Prior work focused on patients undergoing cytotoxic chemotherapy, and often excluded those on supportive care alone. Other contributors to ED visits in oncology, such as patient-level variables, are less well-established. Finally, prior studies focused on ED diagnoses to describe trends and did not evaluate PPEDs. An updated systematic review was completed to focus on PPEDs, novel cancer therapies, and patient-level variables, including those on supportive care alone. Methods Three online databases were used. Included publications were in English, from 2012-2022, with sample sizes of ≥50, and reported predictors of ED presentation or ED diagnoses in oncology. Results 45 studies were included. Six studies highlighted PPEDs with variable definitions. Common reasons for ED visits included pain (66%) or chemotherapy toxicities (69.1%). PPEDs were most frequent amongst breast cancer patients (13.4%) or patients receiving cytotoxic chemotherapy (20%). Three manuscripts included immunotherapy agents, and only one focused on end-of-life patients. Conclusion This updated systematic review highlights variability in oncology ED visits during the last decade. There is limited work on the concept of PPEDs, patient-level variables and patients on supportive care alone. Overall, pain and chemotherapy toxicities remain key drivers of ED visits in cancer patients. Further work is needed in this realm.

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From metrics to practice: identifying preventable emergency department visits for patients with cancer

Cited by 11 publications

References 9 publications

Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care

Characteristics and general practice resource use of people with comorbid cancer and dementia in England: a retrospective cross-sectional study

Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review

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