Self report assessment and support for cancer symptoms: Impact on hospital admissions and emergency department visits.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20552-e20552 ◽  
Author(s):  
Donna Lynn Berry ◽  
Fangxin Hong ◽  
Traci Blonquist ◽  
Barbara Halpenny ◽  
Mary Lou Siefert ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Emergency Department Visits ◽  
Self Report ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Unequal Variance ◽  
Cancer Symptoms ◽  
The Impact

e20552 Background: Attending to symptoms and side effects promotes safe and effective delivery of cancer therapies. Educated and supported patients (Pts) may be able to self-manage symptoms (Sx) and know when to contact the clinician, avoiding emergency department visits (EDV) or hospital admissions (HA). The web-based Electronic Self Report Assessment for Cancer (ESRA-C) is an easy-to-use, automated program for assessing and teaching about symptom and quality of life issues (SQI) and has been shown to improve communication and reduce symptom distress over the course of active therapy. The purpose of this secondary analysis was to explore the impact of the ESRA-C intervention on rates of EDV and HA. Methods: AdultPts with all cancer types and stages treated in medical and radiation oncology at a comprehensive cancer center used ESRA-C to self-report SQI during new anti-cancer therapy, with summary reports delivered to clinicians. Patients were randomized to assessment-only ESRA-C (control) or the ESRA-C intervention adding self-monitoring and education and coaching between clinic visits. We analyzed group differences on EDV and HA using descriptive statistics and a two group unequal variance t-test. Results: Among 663 Pts, 34 out of 327 control Pts made 47 EDV vs 30 out of 336 intervention Pts made 42 visits. Likewise, 36 control Pts had 59 HA vs 36 intervention Pts who had 41 HA during the study duration. The majority of EDV (87%) and HA (88%) were Sx-related. The frequency of Sx-related events (EDV or HA) was higher in the control (n=94) vs the intervention group (n=71). The mean number of unplanned events were 0.29 and 0.21 per patient in the control and intervention groups, respectively (p=0.24). Conclusions: Although the trial sample size was not planned to test differences in EDV or HA, the ESRA-C intervention, compared with assessment alone, may have reduced symptom-related EDV and HA in a large sample of patients during active cancer treatment. If we are able to reduce Sx-related unplanned visits and admissions from more than 1 of 4 patients to 1 of 5 patients with an automated, patient-centered system, we can anticipate substantial cost savings when scaled to the volume of most comprehensive cancer centers. Clinical trial information: NCT00852852.

Effect of a supportive medicine program for cancer patients on patient connectivity to care and health care utilization.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2034-2034
Author(s):  
Brooke Worster ◽  
Gregory D. Garber ◽  
Rebecca Cammy ◽  
Liana Yocavitch ◽  
Ayako Shimada ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Comprehensive Cancer Center ◽  
Categorical Variables ◽  
Cancer Center ◽  
Ed Visits ◽  
The Impact

2034 Background: The benefits of supportive medicine (SM) for cancer patients include improved quality of life, increased patient satisfaction, improved symptom management, increased cost savings and improved survival rates. At one NCI-designated cancer center, all patients were screened for distress; those who screened positive or were directly referred by a provider were enrolled into our multi-disciplinary SM program. Here, we document the impact of the supportive medicine program on outcomes of emergency department (ED) visits, hospital readmission, and non-billable touchpoints associated with patient navigation and resource referrals. Methods: The program systematically screened for biopsychosocial distress utilizing the National Comprehensive Cancer Center Distress Thermometer (DT) and the Problem Checklist (PC) to identify practical, emotional, spiritual and physical issues. Patients were categorized into three types: screened and enrolled in the SM program, and screened and not enrolled in the SM program, or provider referral into the SM program. Data included patient’s age, number of hospital admissions, emergency department visits, and non-billable touchpoints at 90 and 180 days after the distress screening or referral. Descriptive data were analyzed with counts and percentages for categorical variables and summarized with mean and standard deviation for numerical variables. For investigation of the effects of time and patient type on the change in utilization rate, generalized estimation equations for Poisson regression were conducted for each outcome. Results: In all, 2,738 patients were included in the analysis. Patients who were referred from a provider tended to be younger (p < .01) and more likely to die within 90 days (p < .001). At 180 days, ED visits decreased 18% for patients referred to the SM program and 42% for patients screened into the SM program, compared to a 3% decrease in ED visits among those not enrolled in the SM program (p < .01). Similarly, hospital admissions decreased 34% for patients referred to and 39% screened into the SM program, compared to a 4% increase for patients not enrolled in the SM program (p < .01). Non-billable touchpoints increased among all types of patients. Conclusions: An SM program reduces hospital admissions and ED visits, therefore improving outcomes and potentially reducing the cost of care for cancer patients. Future research should link this data to claims data to definitely evaluate the impact of SM programs on cost.

scholarly journals Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial

2011 ◽  
Vol 29 (8) ◽  
pp. 1029-1035 ◽  
Author(s):  
Donna L. Berry ◽  
Brent A. Blumenstein ◽  
Barbara Halpenny ◽  
Seth Wolpin ◽  
Jesse R. Fann ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Clinic Visit ◽  
Self Report ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Control Group ◽  
Cancer Symptoms ◽  
Patient Reported ◽  
Life Issues ◽  
Clinic Visits

Purpose Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment–Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians. Patients and Methods This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians. Results The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. Conclusion The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

scholarly journals The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252441
Author(s):  
Elissa Rennert-May ◽  
Jenine Leal ◽  
Nguyen Xuan Thanh ◽  
Eddy Lang ◽  
Shawn Dowling ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Population Based ◽  
Emergency Department Visits ◽  
System Capacity ◽  
Population Based Study ◽  
Health Measures ◽  
Ed Visits ◽  
The Impact

Background As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. Methods We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). Findings There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. Conclusions Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.

The Impact of RVU-Based Compensation on Patient Safety Outcomes in Outpatient Otolaryngology Procedures

2019 ◽  
Vol 160 (6) ◽  
pp. 1003-1008 ◽  
Author(s):  
Luke Stanisce ◽  
Nadir Ahmad ◽  
Nathan Deckard ◽  
Donald Solomon ◽  
Thomas C. Spalla ◽  
...  
Keyword(s):  
Emergency Department ◽  
Operating Room ◽  
Hospital Admissions ◽  
Incidence Rates ◽  
Adverse Outcomes ◽  
Emergency Department Visits ◽  
Case Volume ◽  
Safety Outcomes ◽  
The Impact ◽  
Surgery Center

Objective To determine the effects an incentive-based physician compensation model has on safety outcomes related to outpatient otolaryngology surgical procedures. Study Design A retrospective analysis of a prospectively maintained database assessing the difference in outpatient surgical volume and postoperative adverse outcomes before and after the implementation of a relative value unit (RVU)–based payment structure. Setting Single-center academic otolaryngology practice operating at a hospital-owned ambulatory surgery center. Subjects and Methods Data prospectively collected from outpatient otolaryngology surgical cases performed at the surgery center from April 2013 to April 2018 were retrospectively reviewed. Equal pre-RVU and post-RVU study periods were calculated for 4 surgeons based on their chronological transition in payment structure (range, 46-56 months). Case volume and incidence rates of adverse outcomes, including postoperative infections, emergency department visits, unplanned hospital admissions, and returns to the operating room, were compared between the pre-RVU and post-RVU study periods at both the surgeon and group levels. Results At the group level, the post-RVU period was associated with a higher volume of surgical cases ( P = .001). No significant differences were observed in the overall incidence of adverse outcomes ( P = .21) or among the specific rates of postoperative hospitalizations ( P = .39), infections ( P = .45), unplanned returns to the operating room ( P = 1.00), or emergency department visits ( P = .39). Comparable results were observed at the individual surgeon level. Conclusion The implementation of an incentive-based salary was not associated with a change in the incidence of adverse safety outcomes in the setting of increased outpatient otolaryngology procedures.

Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department

2016 ◽  
Vol 15 (6) ◽  
pp. 638-643 ◽  
Author(s):  
Julio Silvestre ◽  
Akhila Reddy ◽  
Maxine de la Cruz ◽  
Jimin Wu ◽  
Diane Liu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Education ◽  
Cancer Patients ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Pain Medications ◽  
The Impact ◽  
At Home

AbstractObjective:Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance, which may be a consequence of improper opioid storage, use, disposal, and lack of patient education. We aimed to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency department (ED) of a comprehensive cancer center.Method:We surveyed 113 patients receiving opioids for at least 2 months upon presenting to the ED and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing opioids in plain sight, and unsafe use was defined as sharing or losing opioids.Results:The median age was 53 years, 55% were female, 64% were white, and 86% had advanced cancer. Of those surveyed, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. However, 73% agreed that they would use a lockbox if given one. Patients who reported that others had asked them for their pain medications (p = 0.004) and those who would use a lockbox if given one (p = 0.019) were more likely to keep them locked. Some 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported being prescribed more pain pills than required (p = 0.032) were more likely to practice unsafe use. Most (78%) were unaware of proper opioid disposal methods, 6% believed they were prescribed more medication than required, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Overall, 77% (87) of patients reported unsafe storage, unsafe use, or possessed unused opioids at home.Significance of Results:Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.

scholarly journals Impact of Air Pollution and Trans-Boundary Haze on Nation-Wide Emergency Department Visits and Hospital Admissions in Singapore

2020 ◽  
Vol 49 (2) ◽  
pp. 78-87
Author(s):  
Sze Ling Chan ◽  
Andrew FW Ho ◽  
Huicong Ding ◽  
Nan Liu ◽  
Arul Earnest ◽  
...  
Keyword(s):  
Emergency Department ◽  
Air Pollution ◽  
Hospital Admissions ◽  
Time Of Day ◽  
Emergency Department Visits ◽  
Public Hospitals ◽  
Patient Acuity ◽  
Ed Visits ◽  
The Impact ◽  
Respiratory Conditions

Introduction: Air pollution is associated with adverse health outcomes. However, its impact on emergency health services is less well understood. We investigated the impact of air pollution on nation-wide emergency department (ED) visits and hospital admissions to public hospitals in Singapore. Materials and Methods: Anonymised administrative and clinical data of all ED visits to public hospitals in Singapore from January 2010 to December 2015 were retrieved and analysed. Primary and secondary outcomes were defined as ED visits and hospital admissions, respectively. Conditional Poisson regression was used to model the effect of Pollutant Standards Index (PSI) on each outcome. Both outcomes were stratified according to subgroups defined a priori based on age, diagnosis, gender, patient acuity and time of day. Results: There were 5,791,945 ED visits, of which 1,552,187 resulted in hospital admissions. No significant association between PSI and total ED visits (Relative risk [RR], 1.002; 99.2% confidence interval [CI], 0.995–1.008; P = 0.509) or hospital admissions (RR, 1.005; 99.2% CI, 0.996–1.014; P = 0.112) was found. However, for every 30-unit increase in PSI, significant increases in ED visits (RR, 1.023; 99.2% CI, 1.011–1.036; P = 1.24 × 10˗6) and hospital admissions (RR, 1.027; 99.2% CI, 1.010–1.043; P = 2.02 × 10˗5) for respiratory conditions were found. Conclusion: Increased PSI was not associated with increase in total ED visits and hospital admissions, but was associated with increased ED visits and hospital admissions for respiratory conditions in Singapore. Key words: Epidemiology, Healthcare utilisation, PSI, Public health, Time series

scholarly journals The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years

2016 ◽  
Vol 62 (6) ◽  
pp. 506-512 ◽  
Author(s):  
Rodrigo Locatelli Pedro Paulo ◽  
André Broggin Dutra Rodrigues ◽  
Beatriz Marcondes Machado ◽  
Alfredo Elias Gilio
Keyword(s):  
Emergency Department ◽  
Acute Diarrhea ◽  
Hospital Admissions ◽  
Reduction Rate ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Main Diagnosis ◽  
Ed Visits ◽  
The Impact ◽  
Children Under 5

Summary Introduction: Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1) was added to the Brazilian National Immunization Program. Objectives: To analyze the impact of the RV1 on emergency department (ED) visits and hospital admissions for acute diarrhea. Method: A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003–2005) and the post-vaccine (2007–2009) periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 - odds ratio) x 100. Results: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). Conclusion: The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

scholarly journals Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits

2019 ◽  
Vol 15 (6) ◽  
pp. e501-e509
Author(s):  
Arthur S. Hong ◽  
Thomas Froehlich ◽  
Stephanie Clayton Hobbs ◽  
Simon J. Craddock Lee ◽  
Ethan A. Halm
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Comprehensive Cancer Center ◽  
Secondary Outcome ◽  
Cancer Center ◽  
Control Group ◽  
Interrupted Time Series Analysis ◽  
Care Clinic ◽  
Urgent Care Clinic

PURPOSE: Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer? PATIENTS AND METHODS: We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group. Our primary outcome was emergency department visits within 180 days after a cancer diagnosis, compiled as adjusted monthly rates of emergency department visits per 1,000 patient-months. We analyzed subsequent hospitalizations as a secondary outcome. RESULTS: The rate of weekday emergency department visits was increasing at a rate of 0.43 visits (95% CI, 0.29 to 0.57 visits) per month before May 2012, then fell in half to a rate of 0.19 visits (95% CI, 0.11 to 0.28 visits) per month ( P = .007) after the urgent care clinic was established. In contrast, the weekend visit rate was growing at a rate of 0.08 visits (95% CI, −0.03 to 0.19 visits) per month before May 2012 and 0.05 (95% CI, −0.02 to 0.13 visits; P = .533) afterward. By the end of 2016, there were 15.3 fewer monthly weekday emergency department visits than expected ( P = .005). Trends in weekday hospitalizations were not significantly changed. CONCLUSION: Although only one in eight emergency department–visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.

Reduced symptom burden after visiting an outpatient supportive oncology clinic.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 204-204
Author(s):  
Kathryn C. Wrammert ◽  
Gwendolynn Harrell ◽  
Michael O'Neill ◽  
Anjali Grandhige ◽  
Zachary O. Binney ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Comprehensive Cancer Center ◽  
Rank Test ◽  
Cancer Center ◽  
Small Scale ◽  
Cancer Symptoms ◽  
Supportive Oncology ◽  
The Impact

204 Background: Outpatient palliative care in supportive oncology clinics (SOC) is growing and has shown promise in controlling symptoms. We sought toinvestigate the impact on symptom burden of a SOC in a National Cancer Institute-designated Comprehensive Cancer Center. Methods: New and returning SOC patients referred from our health system’s oncologists from November 2011 through May 2014 completed the Condensed Memorial Symptom Assessment Scale plus a sexual dysfunction structured assessment. Visits include a structured symptom assessment and personalized treatment plan from the clinic’s part-time physician and/or nurse practitioner. Patients rated from 0-4 how bothersome 15 cancer symptoms were. Descriptive statistics were calculated. We used the Wilcoxon signed rank test to compare symptom scores at patients’ first and second visits. Results: 135 patients had multiple SOC visits. Mean age was 54.7 (SD 12.5) years. 55.3% were female. The most common cancers were breast, lung, and head and neck (18.1% each). Median time between visits was 29 days (mean: 52.8, range: 2-446). The most bothersome symptoms at baseline were pain (mean 3.1, SD 1.3), lack of energy (2.4, SD 1.3), and difficulty sleeping (2.1, SD 1.6). Least bothersome were dyspnea (0.8, SD 1.1), sexual problems (0.9, SD 1.4), and nausea (1.0, SD 1.3). Energy, pain, drowsiness, constipation, sleep, worrying, sadness, and nervousness were significantly improved at follow-up with reductions between 0.2 (drowsiness) and 0.5 (pain) points (all p<0.05). Weight loss trended toward improved (p=0.053). Conclusions: 8 of 15 symptoms significantly improved after the first visit to a small-scale SOC. These reductions may underestimate the SOC’s effect if disease was progressing or overestimate differences if disease was shrinking, but such data were unavailable. Larger multi-site trials with well-defined interventions and control groups are needed.

scholarly journals Emergency Department Visits made by Patients with Cancer; Analysis of Data from a Single Community Cancer Center

2019 ◽  
Vol 2 (2) ◽  
pp. 26-35 ◽  
Author(s):  
Meisenberg Barry ◽  
◽  
Rhule RN Jane ◽  
Tan Jessica ◽  
Arvin Laura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care Hospital ◽  
Emergency Department Visits ◽  
Cancer Center ◽  
Specific Method ◽  
Diagnostic Code ◽  
Care Hospital ◽  
Diagnostic Codes ◽  
The Impact ◽  
Active Patients

Purpose: Cancer-related Emergency Department Visits (EDV) are costly and may indicate poor care. Most studies of cancer-related EDV identify patients using inclusive diagnostic codes but lack precision since they don’t distinguish active cancer. We compared estimates of oncology-related EDV made by diagnostic code methods to a more specific method followed by chart review. We also studied characteristics of validated EDV. Methods: EDV from cancer patients at a single acute care hospital were measured using any inclusive oncology codes and was compared to EDV made by patients who were active attendees at cancer clinics. We then reviewed the records of a 50% random sample of the ‘active’ patients to estimate how many were related to cancer or cancer treatment. Results: Over 5 months, 790 oncology-EDV were identified by coding, but only 554 (70%) were made by ‘active’ patients. After review, 29% of active patient EDV was determined not to be related to an oncology problem or treatment. 48% of EDV occurred during daytime clinic hours. 79% were preceded by one or more contacts with the oncology care team within a week. There was variability in the number of EDV by patients of different oncologists. Conclusion: The impact of cancer in overall EDV counts is over-estimated by coding because coding cannot distinguish between active and inactive cancer nor discriminate between symptoms likely due to unlikely due to cancer or cancer treatments. Cancer programs should study the experiences of their own patients to design effective programs to reduce potentially avoidable utilization.

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