Review of the impact of NNRTI-based HIV treatment regimens on patient-reported disease burden

AIDS Care ◽  
2013 ◽  
Vol 26 (4) ◽  
pp. 466-475 ◽  
Author(s):  
Kit N. Simpson ◽  
Kristin A. Hanson ◽  
Gale Harding ◽  
Seema Haider ◽  
Margaret Tawadrous ◽  
...  
Keyword(s):  
Disease Burden ◽  
Hiv Treatment ◽  
Treatment Regimens ◽  
Patient Reported ◽  
The Impact

scholarly journals Patient-Reported Disease Burden and Age: Results from a National Patient Advocacy Survey of Patients with Chronic Lymphocytic Leukemia, Diffuse Large B-Cell Lymphoma and Follicular Lymphoma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4778-4778
Author(s):  
Keith L. Dawson ◽  
Mark A. Price ◽  
Peggy Ann Torney ◽  
Victor Gonzalez ◽  
Maria Sae-Hau ◽  
...  
Keyword(s):  
Older Patients ◽  
Disease Burden ◽  
Negative Impact ◽  
Emotional Health ◽  
B Cell Lymphoma ◽  
Patient Advocacy ◽  
Younger Patients ◽  
Patient Reported ◽  
Equity Ownership ◽  
The Impact

Introduction: Evaluation of patients' psychosocial burden related to their cancer and its treatment is important for shared decision making by patients and their healthcare team. We aimed to better understand the impact of age on this burden as reported by patients with chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma (FL) using data from a large US patient advocacy survey. Methods: We developed a survey to understand patients' perceptions of disease burden and impact on physical and emotional health. The survey was designed through consultation with medical experts, patient advocacy organizations and research team members. Concept elicitation and cognitive pretesting were conducted with patients to inform the survey content. The survey was administered electronically to patients with CLL, DLBCL, or FL who had received either initial or subsequent treatment within the past year. The survey consisted of categorical Likert options that quantified the impact of disease on physical function, sleep, cognition, work, emotional health and quality of life (QoL). The survey data were analyzed descriptively by patients' reported age: 60 years or older versus less than 60 years. Results: The survey was completed by 424 patients who were associated with The Leukemia & Lymphoma Society and/or the Lymphoma Research Foundation (309 patients with CLL, 59 patients with DLBCL and 69 patients with FL). Respondents had a mean age of 66 years (range: 22-95 with five patients electing not to report their age), 79% were 60 years or older, and 51% were female. A greater proportion of younger patients (<60 years) reported negative impact of the disease on various aspects of their lives as compared with older patients. Negative impact on emotional health, on personal relationships and on overall health-related QoL, as well as worry about disease returning or getting worse are highlighted in the following Table. Physical impacts of diseases were also reported in a greater proportion of younger patients versus older patients, specifically in reports of nausea, pain, appetite, sleep patterns, concentration and multi-tasking. Additionally, 95% of patients overall, regardless of age, agreed that delaying disease progression was important to them. Conclusions: Evaluation of disease burden is important as patients and healthcare providers are empowered to take more active roles in shared decision making for treatments that are aligned with patients' concerns and priorities. While patients with CLL, DLBCL, and FL report substantial disease burden, the negative impact of disease was reported in a greater proportion of younger patients (<60 years) than in older patients (≥60 years). Differences in patient-reported disease burden based on age and other patient circumstances should be explored as potential key concerns of patients for education of the clinical community. Disclosures Dawson: Roche/Genentech: Equity Ownership; Genentech: Employment. Price:RTI Health Solutions (RTI-HS): Employment. Sae-Hau:Genentech: Other: The Leukemia & Lymphoma Society received funding from Genentech to participate in this research and also receives programmatic funding from Genentech.. Weiss:Genentech: Other: The Leukemia & Lymphoma Society received funding from Genentech to participate in this research and also receives programmatic funding from Genentech.. Mange:Research Triangle Institute d/b/a RTI Health Solutions: Employment. Mansfield:RTI Health Solutions (RTI-HS): Employment. Comenencia-Ortiz:Genentech, Inc.: Employment. Masaquel:Roche: Equity Ownership; Genentech: Employment. Ravelo:Genentech: Employment, Equity Ownership.

Scalp cooling to reduce alopecia as a barrier to chemotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12537-e12537
Author(s):  
Isabel M. Pupo Wiss ◽  
Dina Hagigeorges ◽  
Chloe J. Walker ◽  
Kelly E. Flanagan ◽  
James T. James ◽  
...  
Keyword(s):  
Hair Loss ◽  
Post Treatment ◽  
Common Disease ◽  
Scalp Cooling ◽  
Treatment Regimens ◽  
Asian Patients ◽  
Patient Reported ◽  
Distress Scale ◽  
The Impact ◽  
To Receive

e12537 Background: Chemotherapy induced alopecia (CIA) is one of the most distressing adverse events reported by patients undergoing chemotherapy, yet there is limited data addressing the impact of CIA on treatment acceptance. Scalp cooling (SC) has been shown to decrease CIA. Here we report our assessment of CIA as a barrier to chemotherapy and the efficacy of SC using pre- and post-treatment surveys of patient reported outcomes. Methods: Patients who received alopecia-inducing chemotherapy and utilized SC between November 2018 and September 2020 at our institution were enrolled in a prospective IRB approved registry. Surveys including the Chemotherapy Induced Alopecia Distress Scale (CADS) were administered before and within two weeks after treatment. Using the CADS survey, patients were asked about their hesitation to receive chemotherapy and the burden they feel about alopecia as a side effect of chemotherapy. Results: Of 90 patients who completed the first or last treatment survey, the most common treatment regimens were docetaxel/cyclophosphamide (TC), docetaxel/carboplatin/trastuzumab/ pertuzumab (TCHP), and paclitaxel/trastuzumab (TH). The most common disease type was breast cancer (92.2%) and all participants were females. Of 74 SC patients who completed the pre-treatment survey, the median age was 50.5 (range 26-75) and included 65 (87.8%) Caucasian, 4 (5.4%) Black, and 3 (4.0%) Asian patients. 89.2% used Paxman SC and 10.8% used Penguin SC. Of those who completed the CADS survey prior to treatment, 8 (10.8%) reported ‘quite a bit’ to ‘very high’ hesitation, and 34 (46.0%) reported feeling that alopecia was either ‘quite’ or ‘very much’ a burden of chemotherapy. All 40 SC patients (median age 53.5, range 31-76) who completed the post-treatment survey were Caucasian and used Paxman SC. Self-reported efficacy of SC in these 40 patients was less than 10% hair loss in 10 (25.0%), 11-25% hair loss in 7 (17.5%), 26-50% hair loss in10 (25.0%), 51-75% hair loss in 9 (22.5%), and 76-100% hair loss in 4 (10%). Overall, 27 (67.5%) patients reported SC limited alopecia ‘a lot’ to ‘perfectly’. Conclusions: In our study, alopecia was identified as a notable burden to nearly half our SC patients and 10.8% hesitated when making their decision to receive chemotherapy. After using SC during treatment, 67.5% of patients reported less than 50% hair loss, and 67.5% reported that SC reduced alopecia ‘a lot’ or ‘perfectly’. Our study highlights the significance of alopecia as a chemotherapy burden and potential barrier to accepting treatment, and suggests SC may be efficacious in decreasing CIA, which may allow patients to feel less hesitation towards chemotherapy.

scholarly journals Development of a novel patient-reported measure for acromegaly: the Acro-TSQ

Pituitary ◽  
2019 ◽  
Vol 22 (6) ◽  
pp. 581-593 ◽  
Author(s):  
Maria Fleseriu ◽  
Leon Fogelfeld ◽  
Murray B. Gordon ◽  
Jill Sisco ◽  
Hilary H. Colwell ◽  
...  
Keyword(s):  
Side Effects ◽  
Disease Burden ◽  
Symptom Control ◽  
Somatostatin Analogs ◽  
Well Being ◽  
The United States ◽  
Daily Activities ◽  
Response Options ◽  
Patient Reported ◽  
The Impact

Abstract Purpose Somatostatin analogs (SSAs) represent a mainstay of medical treatment for acromegaly, currently available as either intramuscular or deep subcutaneous injections. Patient-reported outcomes (PROs) are increasingly common as relevant outcomes in studies of acromegaly and its treatment, but there are no validated PRO measures available that focus on the disease burden and the impact of treatment, specifically designed for use in patients with acromegaly. We sought to develop a new and unique PRO measure, the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ). Methods Concept elicitation (CE) interviews were conducted with acromegaly patients in the United States receiving SSA injections at a stable dose for ≥ 6 months. A questionnaire was drafted based on these interviews; combined CE and cognitive debriefing (CE/CD) interviews were then conducted to confirm the content, clarity, and relevance of the questionnaire. Results Nineteen subjects completed interviews [n = 9 CE, n = 10 CE/CD; n = 15 Lanreotide Depot/Autogel (Somatuline), n = 4 Octreotide LAR (Sandostatin LAR)]. Most subjects responded positively when asked about the effectiveness of their current treatment; however, breakthrough symptoms, injection site reactions, and side effects were commonly reported and had negative impacts on social and emotional well-being and daily activities. All 10 subjects involved in debriefing interviews found the questionnaire to be relevant, easy to complete, and found the response options to be clear. The resulting 26-item Acro-TSQ covers symptoms and symptom control, gastrointestinal side effects and their impact on daily activities, the emotional impact of treatment, convenience and ease of use, and overall satisfaction. Conclusions The Acro-TSQ is a novel PRO, focused on both disease burden and impact of treatment; it was found to be comprehensive, clear, and relevant for patients with acromegaly receiving injectable SSA treatment.

Disease Burden and Treatment Impact Associated with Myelodysplastic Syndromes: Preliminary Findings From a Web-Based Survey.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4522-4522
Author(s):  
Alan F List ◽  
Susan Mathias ◽  
Ross D. Crosby ◽  
Kathy Heptinstall ◽  
David Cella
Keyword(s):  
Quality Of Life ◽  
Data Collection ◽  
Myelodysplastic Syndromes ◽  
Disease Burden ◽  
Full Time ◽  
Intermediate Risk ◽  
Common Diagnosis ◽  
Patient Reported ◽  
The Impact

Abstract Abstract 4522 Purpose Research has led to a better clinical understanding of myelodysplastic syndromes (MDS), but little is known about its burden from the patient perspective. In order to gain insight into the effects of MDS and its treatments on the lives of patients with MDS, patients with MDS self-administered a patient-reported outcomes (PRO) questionnaire. Methods No single comprehensive disease-specific questionnaire currently exists to assess health-related quality of life (HRQoL) in MDS patients. Based on a review of the literature and an understanding of the important issues that MDS patients face, we developed a PRO questionnaire which included: HRQoL items from existing questionnaires; health care resource utilization (HCRU) items including how the MDS diagnosis was made; the use of prior and current treatments; complications associated with treatment; and the impact of symptoms such as thrombocytopenia on usual activities. All adult patients with MDS are eligible to complete the questionnaire one time. Questionnaires are available at patient forums or alternatively patients can complete the survey online via the MDS Foundation website. The questionnaire, includes widely established measures such as the EuroQol (EQ)-5D, the FACT-Th [containing the Functional Assessment of Cancer Therapy (FACT)-General plus the 18 additional items for thrombocytopenia], and some additional questions developed specifically for this study and/or questionnaires currently being used in clinical studies. Data are currently available for the first 82 respondents, and data collection will continue until a total of approximately 200 MDS patients complete the survey. EQ-5D scoring (Index and VAS scores) and FACT (total and thrombocytopenia scale) scores are based on published scoring algorithms. HRQoL comparisons were made across patients based on current hemoglobin levels (< 8 grams/dL versus ≥ 8 grams/dL) and current platelet count values (< 30 × 109/L versus ≥ 30 × 109/L). Results The mean time since MDS diagnosis was 4.1 ± 4.3 years, while the most common diagnosis type was RARS (21%) followed by MDS associated with del (5q) or 5q- (17%). Forty seven percent had low risk, 36% intermediate risk 1, 11% intermediate risk 2 and 6% reported high risk IPSS scores. Mean age was 64.7 ± 11.2 years (range: 29.7 to 82.8) and a slight majority (54%) was male. Twenty six percent worked for pay, while 30% reported they were no longer able to work for pay or had to work part time instead of full time due to their MDS. Although sample sizes were small in the low platelet and low hemoglobin groups as reflected in the table below scores, the EQ-5D and FACT reflected better HRQoL in the higher hemoglobin and higher platelet value groups. Conclusions Results from this study provide valuable preliminary findings on the burden associated with MDS. Once data collection is complete, additional analyses will focus on the influence of current treatment, time since diagnosis, age and gender on disease burden. This PRO instrument is intended to serve as a basis for a quality of life instrument specific to the myelodysplastic syndromes currently under development by the MDS Foundation. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The impact of different (rheumatoid) arthritis phenotypes on patients’ lives

Rheumatology ◽  
2020 ◽  
Author(s):  
Nathalie Luurssen-Masurel ◽  
Angelique Elisabeth Adriana Maria Weel ◽  
Johanna Maria Wilhelmina Hazes ◽  
Pascal Hendrik Pieter de Jong
Keyword(s):  
Disease Activity ◽  
Disease Burden ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Daily Practice ◽  
Treat To Target ◽  
Low Disease Activity ◽  
Patient Reported ◽  
The Impact ◽  
Over Time

Abstract Objectives To compare patient-reported outcome (PRO) domains between three arthritis phenotypes [undifferentiated arthritis (UA), autoantibody-negative RA (RA−) and autoantibody-positive RA (RA+)] at diagnosis, after 2 years and over time. Methods All UA (n = 130), RA− (n = 176) and RA+ (n = 331) patients from the tREACH trial, a stratified single-blinded trial with a treat-to-target approach, were used. PRO comparisons between phenotypes at baseline and after 2 years were performed with analysis of variance, while a linear mixed model compared them over time. Effect sizes were weighted against the minimal clinically important differences (MCIDs) for each PRO. Results RA− patients had a higher disease burden compared with RA+ and UA. At baseline and after 2 years, RA− patients had more functional impairment and a poorer Physical Component Summary (PCS) compared with the other phenotypes, while they only scored worse for general health and morning stiffness duration at baseline. The MCIDs were exceeded at baseline, except for functional ability between RA+ and UA, while after 2 years only the MCID of the PCS was exceeded by RA− compared with UA and RA. After 2 years the PROs of all phenotypes improved, but PROs measuring functioning were still worse compared with the general population, even when patients had low disease activity. Conclusion RA− patients had the highest disease burden of all phenotypes. Although most patients have low disease activity after treatment, all clinical phenotypes still have a similar significant impact on patients’ lives, which is mainly physical. Therefore it is important to assess and address PROs in daily practice because of persistent disease burden despite low disease activity. Trial registration ISRCTN26791028.

scholarly journals Systemic Mastocytosis Patient Experience from Mast Cell Connect, the First Patient-Reported Registry for Mastocytosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4783-4783 ◽  
Author(s):  
Philina Lee ◽  
Tracy I. George ◽  
Hongliang Shi ◽  
Erica K. Evans ◽  
Teghpal Singh ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Mast Cell ◽  
Research Funding ◽  
Disease Burden ◽  
Systemic Mastocytosis ◽  
Employment Equity ◽  
New Therapies ◽  
Patient Reported ◽  
Equity Ownership ◽  
The Impact

Abstract Background: Systemic mastocytosis (SM) is a rare mast cell disorder associated with a range of debilitating symptoms and a shortage of effective treatment options. Little is known about the impact of the disease from the patients' perspective. Systematically characterizing the natural history of SM and its impact on patients will facilitate the development of new therapies. Registries that engage patients have proven valuable in other rare diseases by expanding knowledge of current treatment approaches, evaluating disease burden and accelerating clinical trials. Methods: Mast Cell Connect (NCT02620254, www.mastcellconnect.org) is an observational database that captures demographic, socioeconomic and disease information from patients with mastocytosis. It is the first patient-reported registry for mastocytosis to our knowledge. Key objectives are to improve collective understanding of the disease burden on patients and to facilitate development of new therapies by increasing participation in clinical trials. Enrollment is "site-agnostic" as participants register and take surveys on a secure online portal. Since many US patients are seen outside large clinical centers, this enables broader participation and collection of real-world data. Inclusion criteria are a diagnosis of SM or cutaneous mastocytosis (CM). Diagnoses are self-reported and participants are asked to provide medical reports that will be used to confirm diagnoses in the future. Informed consent is required to join this IRB-approved study. Results: Mast Cell Connect opened on December 1, 2015. As of May 31, 2016, 166 participants had registered, of whom 157 had responded to the online survey. Of the 153 participants who reported their diagnosis, 107 had SM and 38 had CM. Those who reported a diagnosis of SM were categorized as SM participants if they also reported other diagnoses. The current analyses are based on data provided by the 107 SM participants. Of the 107 SM participants, 60 (56%) had Indolent SM (ISM), 8 (7%) had Smoldering SM (SSM), 10 (9%) had Advanced SM (AdvSM, defined as aggressive SM, SM with an associated hematological neoplasm, and Mast Cell Leukemia) and 29 (27%) did not know their subtype. Median age was 50 years (range 4-77). More females participated (74%) than males (26%). Median time from symptom-onset to diagnosis was 7 years. Participants saw a median of 3 specialists prior to diagnosis, most frequently dermatology (67%), allergy/immunology (67%), hematology/oncology (63%) and general practitioner/internal medicine (63%). Specialists diagnosing SM most often included dermatology (36%), allergy/immunology (25%) and hematology/oncology (23%). AdvSM participants were typically diagnosed by hematology/oncology (70%). The medications taken most often at the time of survey were anti-histamines (85% H1 blockers, 72% H2 blockers), leukotriene inhibitors (38%) and cromolyn sodium (33%). Agents to reduce mast cell burden were taken less often (imatinib: 7%, interferon-α: 2%, hydroxyurea: 1% and investigational agents: 1%). Symptoms reported as moderately to severely bothersome included: fatigue (69%), difficulty concentrating (63%), abdominal pain (55%), pain in other locations (53%), difficulty sleeping (53%), itching (46%), diarrhea (45%), bloating (43%), nausea (42%), headache (40%), skin changes (40%), anxiety (39%) and flushing (37%). Participants reported being limited in work or other daily activities "quite a bit" to "very much" in 47% of ISM, 43% of SSM, and 70% of AdvSM cases. Participants' physical condition or medical treatment interfered with their family life "quite a bit" or "very much" in 59% of ISM, 43% of SSM, and 80% of AdvSM cases. Conclusions: Over 160 participants joined Mast Cell Connect in the first 6 months, indicating the mastocytosis community, including The Mastocytosis Society, is highly motivated to participate in research. SM participants reported a diagnostic odyssey, seeing multiple specialists over a median of 7 years prior to diagnosis. Despite frequent use of symptom-directed medications, symptom burden remains substantial and considerably impacts quality of life. Novel therapies targeting the underlying disease are needed. Establishing US centers of excellence may hasten the time to diagnosis. Continued collaboration between researchers, patient advocates and industry is needed to advance the care of patients with SM. Disclosures Lee: Blueprint Medicines: Employment, Equity Ownership. George:Allakos: Research Funding; Novartis: Consultancy; Blueprint Medicines: Consultancy; Allakos: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Seattle Genetics: Consultancy, Research Funding; Incyte: Consultancy; GLG: Consultancy; Wiley Blackwell: Consultancy; American Registry of Pathology: Patents & Royalties; Wolters Kluwer: Patents & Royalties; UpToDate: Patents & Royalties. Shi:Blueprint Medicines: Employment, Equity Ownership. Evans:Blueprint Medicines: Employment, Equity Ownership. Singh:Blueprint Medicines: Employment, Equity Ownership. Boral:Blueprint Medicines: Employment, Equity Ownership. Rangel Miller:PatientCrossroads: Employment, Equity Ownership.

Associations Between Treatment Restrictions, Patient-Reported Treatment Burden and Adherence to Tyrosine-Kinase Inhibitor Therapy Among Chronic Myeloid Leukemia Patients in the United States and Europe

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2077-2077
Author(s):  
Shaloo Gupta ◽  
Amir Goren ◽  
Timothy W Victor ◽  
Jonathan Chapnick ◽  
Stephanie Hawthorne ◽  
...  
Keyword(s):  
Research Funding ◽  
Kinase Inhibitor ◽  
The United States ◽  
Current Treatment ◽  
Treatment Regimens ◽  
Dietary Restrictions ◽  
Patient Reported ◽  
Tki Treatment ◽  
The Impact ◽  
Treatment Restrictions

Abstract Abstract 2077 Background: The availability of the tyrosine-kinase inhibitor (TKI), imatinib, and later introduction of second generation TKIs, dasatinib and nilotinib, have not only improved the clinical outcomes of patients with chronic myeloid leukemia (CML), but have also provided multiple therapeutic options for CML patients. Despite the widespread use of these oral therapies, little is known about the impact of different treatment regimens on overall treatment burden and adherence among CML patients. Objective: The objective of this cross-sectional survey conducted in the United States (US) and Europe (EUR) was to assess the overall CML disease management and treatment experience from the patient's perspective. This analysis evaluates the impact of dosing and dietary restrictions on patient-reported adherence and difficulty following oral TKI treatment regimens. Methods: This study included patients identified from the National Health and Wellness Survey and Lightspeed Research Chronic Illness Panel aged ≥18 years from the US and EUR (United Kingdom, Spain, France, Italy, and Germany) who had a diagnosis of CML, were in chronic phase, and were currently on TKI treatment or on a drug holiday. Patients completed a web based self-administered questionnaire. Relevant measures of treatment restrictions, including dietary restrictions (while fasting, with food, without certain foods, with water, at specific time intervals, or without certain non-CML meds) and dosing regimens (once a day, twice a day, two or more pills at one time, or at specific times of day) were compared across TKIs. Outcomes included CML treatment adherence (TKI dose was missed/skipped or taken less than prescribed over the past 4 weeks) and treatment difficulty (patient-reported difficulty in following treatment regimens - Yes/No). A composite score of overall dietary restrictions was constructed for each patient to assess associations with patient-reported treatment difficulty and adherence using a structural equation model (SEM). Results: A total of 303 respondents participated in the study (50% from US), of which 68.6% reported current treatment as imatinib, 12.5% dasatinib and 16.2%nilotinib (2.7% reported other). Mean age was 51.5 years (standard deviation [SD] = 13.6), 46.2% were male, and mean time since diagnosis was 4.8 years (SD = 4.5), with 12.3% of patients within 12 months of diagnosis. The majority of patients reported being adherent to their CML treatment, with 25.4% stating missed doses within the past 4 weeks. Approximately 30% reported difficulty in following treatment regimens; treatment difficulty was substantially higher among nilotinib (63.3%) than among dasatinib (3.7%) or imatinib (22.9%) treated patients (p<0.0001). Overall dietary restriction scores (ranging from -1.33 to 1.60, with positive values indicating greater restrictiveness) were low among dasatinib (mean score= −0.31) and imatinib users (-0.06), whereas overall scores were significantly higher among nilotinib users (mean= 0.61; p<0.0001). Although dietary restrictions were not significantly associated with self-reported adherence (p=0.24), results of the SEM model indicated that higher overall dietary restriction scores were associated with significantly greater difficulty in taking medication as required (beta=0.28, p<0.001). Conclusions: Dietary restrictions were strongly associated with patients reporting difficulty with current treatment regimens. Patients receiving dasatinib and imatinib reported fewer dietary and dosing restrictions than did patients receiving nilotinib. Choosing a regimen that requires fewer overall dosing restrictions may be an important consideration for treatment choice in CML patients. Disclosures: Gupta: Bristol-Myers Squibb: Research Funding. Goren:Bristol-Myers Squibb: Research Funding. Victor:Bristol-Myers Squibb: Research Funding. Chapnick:Bristol-Myers Squibb: Research Funding. Hawthorne:Bristol-Myers Squibb: Research Funding. Hirji:BMS: Employment. Olavarría:Bristol-Myers Squibb: Consultancy. Moadel:Bristol-Myers Squibb: Consultancy. Lemoine:Bristol-Myers Squibb: Consultancy. Davis:Bristol-Myers Squibb: Employment.

Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

2020 ◽  
Vol 32 (4) ◽  
pp. 523-532 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Mohamad Bydon ◽  
John Knightly ◽  
Mohammed Ali Alvi ◽  
Anshit Goyal ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Care ◽  
Body Mass ◽  
Care Facility ◽  
Older Age ◽  
Quality Outcomes ◽  
Acute Care Facility ◽  
Factors Associated ◽  
Patient Reported ◽  
The Impact

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

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