The Use of a Bone Marrow Transplant Program Public Website for Patient Education and Reporting of Outcomes: Increased Use Resulting in Improved Patients’ Trust and Assurance.

Abstract To promote patient education, the Dartmouth Bone Marrow Transplant (BMT) Program created a website focusing on Quality Reports, highlighting outcomes and patient satisfaction data. In an attempt to address areas most important to potential patients, the development of the website involved Transplant physicians and nurses, outside reviewers and recently transplanted patients. Based on these assessments and interviews, the BMT website was designed to provide various outcome data, including disease-specific overall- and disease-free survival, length of stay, and incidence of nausea. The website became public in January 2004. The use of the public website was evaluated 18 months after initiation. There was a 300% increase in external user visits to the Dartmouth BMT Website (comparing 3 month averages). Eighty percent of the information accessed was in the topic of “Safe and Effective Care”, which addresses patient-specific data, including survival statistics, length of stay, or toxicities during the transplant. The remaining 20% of interest was satisfaction measures addressing patients’ view of their overall care, opinions addressing nursing care or physician interaction. Of the top ten measures that were evaluated by users, the first 9 were disease-specific survival statistics and the remaining was “Average Length of Hospital Stay”. Individual interviews with patients (n=16) indicate that the information provided on the web site increased the trust of the institution. In addition, patients felt re-assured concerning their selection of our institution. In conclusion, the initiation of the Dartmouth BMT Quality Reports Website (http://www.dhmc.org/QualityReports) that focuses on outcome data resulted in a marked increased use of the Dartmouth BMT Website within 18 months. Patients were most interested in disease-specific survival statistics, followed by transplant patients’ opinions of their care. Patients report that the “transparency” of outcome results and the patient education provided by the website improve their trust of our BMT program/hospital and foster assurance of our institution’s reputation.

Download Full-text

Quality Improvement: Decreasing Length of Stay and Readmission Rates for Bone Marrow Transplant Patients

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2013.12.190 ◽

2014 ◽

Vol 20 (2) ◽

pp. S126

Author(s):

Jason Scott Starr ◽

Erin Mobley ◽

Vivek Roy ◽

John Wade ◽

Virginia Lesperance

Keyword(s):

Bone Marrow ◽

Quality Improvement ◽

Length Of Stay ◽

Bone Marrow Transplant ◽

Marrow Transplant ◽

Readmission Rates ◽

Transplant Patients

Download Full-text

Comparative Cost Analysis of Therapy in Sickle Cell Anemia: Supportive Care Vs. Bone Marrow Transplant

Blood ◽

10.1182/blood.v126.23.4466.4466 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4466-4466 ◽

Cited By ~ 1

Author(s):

Pooja Lothe ◽

Tiffany Pompa ◽

Maneesh Jain ◽

Parshva Patel ◽

Yayu Liang ◽

...

Keyword(s):

Bone Marrow ◽

Sickle Cell Disease ◽

Length Of Stay ◽

Bone Marrow Transplant ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Hospital Admissions ◽

Marrow Transplant ◽

Cell Disease ◽

The Cost

Abstract Objective: A comparative cost analysis of sickle cell admissions vs. stem cell transplants in sickle cell patients. Hypothesis: We believe the overall cost of a bone marrow transplant for a sickle cell patient will be less than that of a patient with multiple sickle cell admissions. Background: Sickle cell disease remains an increasing burden to the cost of health care and health care providers. The disease results in a variety of serious organ system complications that can lead to life-long disabilities and/or early death. Despite the advent of hydroxyurea, sickle cell admissions and cost have been increasing over the course of several years. Various contributing factors may include socioeconomic status, complications of sickle cell anemia itself, narcotic dependence and noncompliance with medications. Bone marrow transplants were introduced in 1982 as an option for the treatment of sickle cell anemia, and are currently the only curative option in this disease. A study conducted at the NIH from 2004-2013, found that bone marrow transplant reversed the disease in 26 of 30 patients (87%) (Hseih et al, N Engl J Med 2009; 361:2309-2317). The patients ultimately had a normal hemoglobin, fewer hospitalizations, and lower use of narcotics to treat pain from the disease. However, the underutilization of bone marrow transplant continues to exist and may in part be secondary to a lack of fully matched donors. To overcome this challenge, the Johns Hopkins group developed a nonmyeloablative bone marrow transplantation platform using HLA haploidentical donors for patients using posttransplant cyclophosphamide. As a result, 17 patients were successfully transplanted, 14 from HLA-haploidentical and 3 from HLA-matched related donors (Meade et al, Blood. 2012; 120(22):4285-4291). Due to this, most patients with sickle cell disease have the potential to undergo a successful bone marrow transplant. However, an analysis comparing the cost of admissions vs. transplant has yet to be determined. In order to create an effective cost comparison, we utilized a nationwide database. Methods: US hospital admissions were identified from discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 1998 to 2011 using ICD9 codes. Admissions were included if they had an ICD9 code for Sickle cell anemia (282.5). Results: Table 1. Year 1998 1999 2000 2001 2002 2003 2004 Length of Stay (Days) 6.21 6.13 6.37 6.19 6.46 6.31 6.05 Cost ($) 15,724.00 16,465.00 18,654.00 18,750.00 22,587.00 24,501.00 23,743.00 Table 2. Year 2005 2006 2007 2008 2009 2010 2011 Average Length of stay (Days) 6.16 6.13 6.00 5.91 5.62 5.71 5.61 6.04 Cost ($) 25,129.00 27,471.00 28,425.00 27,314.00 29,767.00 29,929.00 31,683.00 24,687.00 The cost per hospitalization has almost doubled since 1998, despite a slight decrease in length of stay from an average of 6.5 days to 5.6 days from 1998-2011. According to the data base from our study, the average cost per patient per hospitalization was $24,687. The average number of admissions per year for a single patient with sickle cell anemia is 6 (Ballas et al, Am J Hem 2009) for an estimated overall cost per year of $148,000. However, this value underestimates the true cost since this does not include emergency room visits, medicine costs, and readmission rates. Conclusion: In the age of cost effective medicine, clinicians struggle to find a balance between low cost and optimal patient care. An underutilized modality of care and even cure for sickle cell disease is bone marrow transplant. The sickle cell information center website estimates the cost of the transplant process for most patients to be $150,000 to $250,000 which includes pre-transplant evaluation, transplant stay, and post-transplant follow-up (https://scinfo.org). We estimate that a bone marrow transplant is approximately equivalent to the cost of ten sickle cell hospital admissions. According to this analysis, undergoing a bone marrow transplant would ultimately prove to be more cost efficient while decreasing the rate of complications associated with this debilitating disease. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Acute Myeloid Leukemia in the Elderly: Trends in Mortality Rates, Hospital Cost, Length of Stay, and Complication Rates in Patients Aged 60 and Older

Blood ◽

10.1182/blood.v128.22.2359.2359 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2359-2359

Author(s):

Ankit Shah ◽

Stuthi Perimbeti ◽

Parshva Patel ◽

Rachel Nathan ◽

Seema Niphadkar ◽

...

Keyword(s):

Bone Marrow ◽

Length Of Stay ◽

Hospital Mortality ◽

Bone Marrow Transplant ◽

Marrow Transplant ◽

Teaching Hospitals ◽

Complication Rates ◽

Total Cost ◽

Significant Difference ◽

Acute Myeloid

Abstract Background: Acute myeloid leukemia (AML) is associated with a high mortality rate. Advancing age is a risk factor associated with poor prognosis and an increased rate of chemotherapy-related complications in patients with AML. We aimed to evaluate trends in cost of hospitalizations, length of stay, mortality rates, and complication rates in patients aged 60 years and older who were admitted for active AML. We also sought to elucidate differences in these outcomes in teaching and non-teaching institutions. Methods:We queried the Nationwide Inpatient Sample (NIS) between 1999 and 2013 using the ICD-9 codes 205.00, 205.01, 206.00, and 206.01 for acute myeloid and acute monocytic leukemias in the primary diagnosis field. Admission data regarding total cost, length of stay (LOS), and in-hospital mortality was extracted. This data was trended over the 15-year interval and comparisons were made between teaching and nonteaching institutions. Incidence of in-hospital complications including clostridium difficile infection (CDI), bacteremia, sepsis, pneumonia, venous thromboembolism (VTE), neutropenic fever, candidiasis, urinary tract infection (UTI), and acute respiratory failure were determined and compared in subsets of teaching and nonteaching hospitals. Frequency of bone marrow transplant was also determined in both hospital settings. Results: A total of 51,684 (weighted n=247,747) admissions for AML occurred from 1999-2013. Of these 31,004 admissions (weighted n=148,683) were in patients aged 60 and older. Most of these elderly admissions occurred at teaching institutions (n=17,593, weighted n=84,829). In-hospital mortality was higher in patients aged 60 and greater (23.68%) compared to those less than 60 (13.7% (p<.0001)). For patients 60 and older, mortality has decreased by approximately 40% during the 15-year interval (p<.0001). Specifically, in-hospital mortality was 30.21% in 1999 and 18.05% in 2013. In comparing teaching and non-teaching hospitals, mortality rate was not found to have a statistically significant difference (p=.4473). Complication rates due to VTE, bacteremia, febrile neutropenia, pneumonia, and UTI increased during this time period. Rates of CDI and candidiasis did not have a statistically significant difference over time. Rates of acute respiratory failure, neutropenic fever, bacteremia, VTE, sepsis, and CDI were higher at teaching than at non-teaching institutions (p<.0001). Rates of UTI were higher at non-teaching (9.62%) than at teaching institutions (8.43% (p=.004)). Differences in the rate of pneumonia and candidiasis were not statistically significant between the two hospital settings. Rates of bone marrow transplant have roughly doubled from .23% in 1999 to .51% in 2013 (p=.0079) and occurred more frequently in teaching (0.54%) than in non-teaching (0.24%) hospitals (p=.0017). Mean LOS (days) is relatively unchanged over the 15- year interval (p=.2277), however, cost has increased dramatically (p=.0001). Total cost in 1999 was $46,833(±1,508), whereas in 2013 it was $146,965(±4,296). Mean LOS and cost were higher at teaching (17.16, $122,257±1,221) compared with nonteaching (10.57, $65,448±993) institutions (p=.0001). Conclusions: For patients admitted with a primary diagnosis of active AML, in-hospital mortality was markedly higher in patients aged 60 and older compared with those less than 60. In the elderly, in-hospital mortality decreased dramatically between 1999 and 2013. Many factors may contribute to the decrease in mortality in this population including the use of less-aggressive cytotoxic chemotherapy, such as low-dose cytarabine or hypomethylating agents, improved adherence to preventative practices including the use of high-efficiency particulate air filtration, and prophylactic antibiotics. In patients older than 60, LOS and total cost were higher in teaching institutions, although in-hospital mortality was similar. In general, complication rates were higher at teaching hospitals, which may be a consequence of increased medical complexity and more aggressive therapy offered at these hospitals. For instance, bone marrow transplant rates were much higher in teaching than in non-teaching hospitals. Further research is required to determine the exact factors and practice differences contributing to the discrepancies between teaching and non-teaching institutions. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Differences in length of stay among hospitalized children with acute lymphoblastic leukemia

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.10044 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 10044-10044

Author(s):

E. Tai ◽

L. Richardson ◽

J. Townsend ◽

B. Steele

Keyword(s):

United States ◽

Bone Marrow ◽

Acute Lymphoblastic Leukemia ◽

Length Of Stay ◽

Bone Marrow Transplant ◽

Household Income ◽

Lymphoblastic Leukemia ◽

Marrow Transplant ◽

Hospitalized Children ◽

Clinical Complications

10044 Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy among children in the United States. While age, race, and clinical complications have been associated with longer length of stay (LOS) among children with cancer, it is unknown what factors are related to LOS among children with ALL. We examined differences in LOS among hospitalized children with ALL. Methods: We used 2000, 2003, and 2006 data from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) which contains pediatric discharges from community, non-rehabilitation hospitals. We used negative binomial regression to determine factors related to LOS. Results: We found the following factors related to greater LOS among hospitalized children with ALL: Non-Hispanic blacks vs. non-Hispanic whites (Rate Ratio (RR) = 1.06, CI:1.03–1.10), Hispanics vs. non-Hispanic whites (RR = 1.07, CI:1.04–1.10), age < 1 year vs. age 1–5 years (RR = 1.93, CI:1.83–2.04), female vs. male (RR = 1.05, CI:1.03–1.07), lowest quartile of household income in patient's zip code vs. highest quartile (RR = 1.09, CI:1.06–1.12), Medicaid vs. private insurance (RR = 1.11, CI:1.09–1.14), children's hospital vs. non-children's (RR = 1.11, CI:1.08–1.14), Western region of United States vs. Northeast region (RR = 1.14, CI:1.11–1.17), emergency room admission vs. routine admission (RR = 1.23, CI:1.20–1.26), blood transfusion (RR = 1.64, CI:1.61–1.67), bone marrow transplant (RR = 7.64, CI:7.11–8.20), and neutropenia (RR = 1.22, CI:1.19–1.24). Conclusions: Race/ethnicity, age, sex, household income, insurance status, admission source, hospital type and region, transfusion, bone marrow transplant, and neutropenia were significantly associated with longer LOS. These factors may help identify children with ALL at risk for complications. Prophylactic treatment for clinical complications may reduce LOS. No significant financial relationships to disclose.

Download Full-text