Impact of a Dedicated Cancer Urgent Care Center on Acute Care Utilization

Abstract

PURPOSE: Acute care imposes a significant burden on patients and cancer care costs. We examined whether an advanced practice provider-driven, cancer-specific urgent care center embedded within a large tertiary academic center decreased acute care use among oncology patients on active therapy. MATERIALS AND METHODS: We conducted a quasi-experimental study anchored around the Oncology Extended Care Clinic (OECC) opening date. We evaluated two parallel 4-month periods: a post-OECC period that followed a 5-month run-in phase, and the identical calendar period 1 year earlier. Our primary outcomes included all emergency department (ED) presentations and hospital admissions during the 3-month window following the index provider visit. We used Poisson models to calculate absolute pre-OECC v post-OECC rate differences. RESULTS: Our cohort included 2,095 patients in the pre-OECC period and 2,188 in the post-OECC period. We identified 32.6 ED visits/100 patients and 41.2 hospitalizations/100 patients in the pre-OECC period, versus 28.2 ED visits/100 patients and 26.1 hospitalizations/100 patients post-OECC. After adjusting for age, sex, race and ethnicity, and practice location, we observed a significant decrease of 4.6 ED visits/100 patients during the post-OECC period (95% CI, –8.92/100 to –0.28/100; P = .04) compared with the pre-OECC period. There was no significant association between the OECC opening and hospitalization rate (rate difference: –3.29 admissions/100 patients; 95% CI, –8.24/100 to 1.67/100; P = .19). CONCLUSION: Establishing a cancer-specific urgent care center was significantly associated with a modest decrease in emergency room utilization but not with hospitalization rate. Barriers included clinic capacity, patient awareness, and physician comfort with advanced practice provider autonomy. Optimizing workflow and standardizing clinical pathways can create benchmarks useful for value-based payments.

Establishing Regionalized Acute Care Across a Health Care System to Decentralize Postoperative Care After Oncologic Surgery

“…One report specifically described an APP-led model of a dedicated cancer-specific UCC that demonstrated decreases in emergency department visits and admissions. 18 APPs are clearly an essential component of our program, and this report supports their safe and effective involvement in acute care assessment. To our knowledge, the work presented here is the first report of a program addressing acute care needs for patients after cancer surgery, directly answering the call of the NCI working group studying the burden of unscheduled acute care in patients with cancer.…”

Oncologic emergencies and urgencies: A comprehensive review

“…Although growing numbers of large community oncology practices and tertiary cancer centers have established dedicated, high-acuity, same-day oncology urgent care centers, many patients still require general ED care for acute symptom management. 4,5 Here, we present a comprehensive review of the clinical aspects of oncologic urgencies and emergencies, including sections discussing paraneoplastic syndromes, structural complications, and adverse events associated with chemotherapy, radiotherapy, and targeted therapies, with the latter including each of small-molecule, monoclonal antibody, and cell-based therapeutics. We also include sections that discuss the management of previously undiagnosed cancers that present emergently, pain crisis, and end-of-life care in the ED as well as discuss areas of future research (Fig.…”

“…These emergencies represent a wide spectrum of disorders resulting from initial manifestations of malignancy, progression of known disease, recurrence of a previous cancer, and adverse effects from therapy, and some can be life‐threatening. Although growing numbers of large community oncology practices and tertiary cancer centers have established dedicated, high‐acuity, same‐day oncology urgent care centers, many patients still require general ED care for acute symptom management 4,5 . Here, we present a comprehensive review of the clinical aspects of oncologic urgencies and emergencies, including sections discussing paraneoplastic syndromes, structural complications, and adverse events associated with chemotherapy, radiotherapy, and targeted therapies, with the latter including each of small‐molecule, monoclonal antibody, and cell‐based therapeutics.…”

An Oncology Urgent Care Clinic for the Management of Immune-Related Adverse Events: A Descriptive Analysis

“…Over the past decade, several oncology centers created dedicated urgent care clinics (UCCs) as intermediaries between the clinic and the Emergency Department (ED) or inpatient care. Oncology UCCs demonstrate adequate triaging and potentially reduce overall ED visits without delays in care [ 1 , 2 , 3 ]. In 2018, the Sidney Kimmel Thoracic Oncology Clinic at Johns Hopkins Bayview Medical Center (JHBMC) created the UCC co-located in the cancer clinic.…”

“…One perceived benefit of UCCs is the identification of treatment-related toxicities, including immune checkpoint inhibitors (ICI). Healthcare systems increasingly need to identify and manage immune-related adverse events (irAEs), which are unique and require different diagnostic and management pathways often involving non-oncology subspecialists and services [ 1 , 2 , 4 ]. In some reports, 13–32% of ED presentations are for confirmed irAEs in patients receiving ICIs [ 5 , 6 ].…”