A retrospective evaluation of unplanned hospital admission rates for women with ovarian cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18129-e18129
Author(s):  
Shayan M Dioun ◽  
Eirwen Murray Miller ◽  
Joan Tymon-Rosario ◽  
Dennis Yi-Shin Kuo ◽  
Nicole Suzanne Nevadunsky
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Hospital Admission ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Care Model ◽  
Metabolic Disturbances ◽  
Racially Diverse ◽  
Admission Rates ◽  
Oncology Care

e18129 Background: Unplanned admission following chemotherapy is a measure of quality cancer care. Large retrospective datasets have shown admission rates 10-35% in women with ovarian cancer receiving chemotherapy. It is unclear whether the Oncology Care Model is sustainable based on these admission rates. We sought to evaluate the rate and risk factors for hospital admission following chemotherapy in our racially diverse urban population. Methods: After IRB approval, all patients with epithelial ovarian cancer who received chemotherapy at our institution from 2005-2016 were identified. Charts were retrospectively reviewed for clinicopathologic data. Categorical variables were compared with chi-squared and continuous variables with the student t-test. Results: 222 evaluable patients were identified. 37 (17%) patients had unplanned admissions following initial chemotherapy. Indications for admission included neutropenic fever (9), abdominal pain (15), metabolic disturbances (2), infection (3), and other (8). The median number of days from chemotherapy to admission was 8 (IQR 7-18.5). No significant differences were seen in race, medical co-morbidities, age, or BMI in admitted patients. Stage and primary neoadjuvant chemotherapy were predictive of admission. Conclusions: Unplanned hospital admission rates following initial chemotherapy in our racially diverse patient population are consistent with previously reported rates. Though age and medical co-morbidities did not predict admission, stage and primary neoadjuvant chemotherapy were predictive of subsequent admission. The Oncology Care Model may not account for hospital admission rates of this magnitude and further investigation is needed to identify predictors of hospitalization and poor outcomes. [Table: see text]

African American women with advanced-stage ovarian cancer have worse outcomes regardless of treatment type

2020 ◽  
Vol 30 (7) ◽  
pp. 1018-1025 ◽  
Author(s):  
Gabrielle Whitmore ◽  
Amin Ramzan ◽  
Jeanelle Sheeder ◽  
Saketh R Guntupalli
Keyword(s):  
Ovarian Cancer ◽  
African American ◽  
Neoadjuvant Chemotherapy ◽  
African American Women ◽  
Continuous Variables ◽  
Debulking Surgery ◽  
American Women ◽  
Primary Debulking Surgery ◽  
Treatment Type ◽  
To Receive

ObjectiveThere has been an increase in the use of neoadjuvant chemotherapy in recent years. Our objective was to determine if African American women are more likely to receive neoadjuvant chemotherapy than primary debulking surgery, when compared to their Caucasian counterparts, and the impact of such an approach on oncologic outcomes.MethodsA retrospective cohort study was performed using the National Cancer Database (NCDB). Women aged 18–90 years, diagnosed with stage IIIC or IV epithelial ovarian cancer between January 2010 through December 2014 were included. Women with unknown treatment or treatments outside of neoadjuvant chemotherapy or primary debulking surgery were excluded. Only women of Caucasian, African American, or Hispanic origin who received either neoadjuvant chemotherapy or primary debulking surgery were included; all other races were excluded. Descriptive statistics were computed, and continuous variables were assessed for normality. Groups were compared using ANOVA or non-parametric medians tests for continuous variables, and chi-squared tests were used for dichotomous or categorical variables. Logistic regression was used to identify predictors of treatment. A p value of 0.05 was considered statistically significant.ResultsA total of 19 838 women with stage IIIC and IV epithelial ovarian cancer met the inclusion criteria. A total of 14 988 (75.6%) were treated with primary debulking surgery, while 4850 women (24.4%) were treated with neoadjuvant chemotherapy. Of those treated with neoadjuvant chemotherapy, 24.5% were white, 27.0% were African American, and 22.1% were Hispanic (p=0.005), and when adjusted for confounders, being African American was a predictor of receiving neoadjuvant chemotherapy (adjusted odds ratio (aOR) 1.29, 95% CI 1.10 to 1.51). Ninety-day mortality rates were higher in African American women compared with Caucasian and Hispanic women (2.9% vs 2.0% vs 1.6%, p=0.013). There were no differences in 30-day mortality, 90-day mortality, or status at last contact in African American women, when comparing neoadjuvant chemotherapy and primary debulking surgery. In Caucasian women, outcomes were worse in women receiving neoadjuvant chemotherapy.ConclusionsCompared to other races, African American women with advanced ovarian cancer are more likely to receive neoadjuvant chemotherapy than primary debulking surgery and had a higher 90-day mortality rate. In African American women there was no difference in outcomes based on treatment type.

scholarly journals A descriptive report of outcomes of primary mucinous ovarian cancer patients receiving either an adjuvant gynecologic or gastrointestinal chemotherapy regimen

2019 ◽  
Vol 29 (5) ◽  
pp. 904-909
Author(s):  
Brooke A Schlappe ◽  
Qin C Zhou ◽  
Roisin O'Cearbhaill ◽  
Alexia Iasonos ◽  
Robert A Soslow ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Free Survival ◽  
Exact Test ◽  
Clinical Criteria ◽  
Kaplan Meier

ObjectiveWe described progression-free survival and overall survival in patients with primary mucinous ovarian cancer receiving adjuvant gynecologic versus gastrointestinal chemotherapy regimens.MethodsWe identified all primary mucinous ovarian cancer patients receiving adjuvant gynecologic or gastrointestinal chemotherapy regimens at a single institution from 1994 to 2016. Gynecologic pathologists using strict pathologic/clinical criteria determined diagnosis. Adjuvant therapy was coded as gynecologic or gastrointestinal based on standard agents and schedules. Clinical/pathologic/treatment characteristics were recorded. Wilcoxon rank-sum test was used for continuous variables, and Fisher’s exact test for categorical variables. Progression-free and overall survival were calculated using the Kaplan-Meier method, applying landmark analysis.ResultsOf 62 patients identified, 21 received adjuvant chemotherapy: 12 gynecologic, 9 gastrointestinal. Median age (in years) at diagnosis: 58 (range 25–68) gynecologic cohort, 38 (range 32–68) gastrointestinal cohort (p=0.13). Median body mass index at first post-operative visit: 25 kg/m2(range 18–31) gynecologic cohort, 23 kg/m2(range 18–31) gastrointestinal cohort (p=0.23). History of smoking: 6/12 (50%) gynecologic cohort, 3/9 (33%) gastrointestinal cohort (p=0.66). Stage distribution in gynecologic and gastrointestinal cohorts, respectively: stage I: 9/12 (75%) and 3/9 (33%); stage II: 2/12 (17%) and 1/9 (11%); stage III: 1/12 (8%) and 5/9 (56%) (p=0.06). Grade distribution in gynecologic and gastrointestinal cohorts, respectively: grade 1: 8/12 (67%) and 1/9 (13%); grade 2/3: 4/12 (33%) and 7/9 (88%) (p=0.03). Three-year progression-free survival: 90.9% (95% CI 50.8% to 98.7 %) gynecologic, 53.3% (95% CI 17.7% to 79.6%) gastrointestinal. Three-year overall survival: 90.9% (95% CI 50.8% to 98.7%) gynecologic, 76.2% (95% CI 33.2% to 93.5%) gastrointestinal.ConclusionOngoing international collaborative research may further define associations between chemotherapy regimens and survival.

Emergency Department Management of Children with Sickle Cell Disease.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1660-1660
Author(s):  
Melissa J. Frei-Jones ◽  
Amy L. Baxter ◽  
Charles T. Quinn ◽  
George R. Buchanan
Keyword(s):  
Emergency Department ◽  
Steady State ◽  
Sickle Cell Disease ◽  
Hospital Admission ◽  
Sickle Cell ◽  
Admission Rate ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cell Disease ◽  
Ed Visits

Abstract Vaso-occlusive crises (VOC) are a common cause of emergency department (ED) visits for children with sickle cell disease (SCD). To better understand our patient population and compare with reports from other centers, we sought to describe the presentation, management, and disposition of children with VOC at our center’s ED. We also aimed to identify predictors of hospital admission. We retrospectively reviewed hospital records of all patients with SCD, age 8–19 years, who presented to our urban pediatric ED in 2003 with a chief complaint of pain. We identified all subjects diagnosed with VOC and not another cause of pain. We obtained the following data for each: SCD genotype; duration of VOC and treatment prior to ED presentation; the nature of analgesia and use of intravenous fluids (IVF) in the ED; hemoglobin (Hgb) concentration; and disposition (admitted, discharged, discharged with subsequent ED visit for same crisis). Categorical variables were evaluated by the χ2 and Fisher exact tests and continuous variables by the t-test. Odds ratios (OR) and 95% confidence intervals (CI) were calculated where appropriate. In 2003, there were 320 ED visits for patients with SCD and pain. Among these, there were 279 diagnoses of VOC in 105 individual patients: 45 had one visit, 25 two visits, and 16 ≥5 visits. Mean number of visits per patient was 2.7; 23 (22%) patients accounted for 145 (55%) visits. Homozygous sickle cell anemia (Hgb SS) was present in 73/105 patients, accounting for 222 (79%) ED visits. Overall admission rate was 179/279 (64%), with 167/179 admitted on their first visit and 12 on their return visit. Subjects with Hgb SS accounted for 147/179 (82%) admissions. Among those discharged who later returned to the ED during the same VOC, the admission rate was 86% (5 returned in 24 hours, 5 in 48 hours, 3 in 72 hours, and one 4 days later). Pre-ED home opioid use was reported in 75% of visits and was associated with increased likelihood of discharge (OR 1.63, CI 0.94–2.84, p=0.082). Duration of VOC before presentation did not significantly affect admission rate and averaged 53.2 hours for admitted patients and 49.7 hours for those discharged (p=0.689). Patients who received IVF in the ED (219/279; 79%) were less likely to be admitted (31% vs 56%, p<0.001). Hgb concentration was increased in 61%, decreased in 36% and unchanged in 3% of patients from steady-state values and was not associated with admission. After receiving 2 doses of morphine, 31 patients were discharged from the ED, while only 5 patients were discharged after receiving 3 or 4 doses of morphine. A departmental VOC protocol was followed for 25.4% of patients, with no impact on admission rate (p=0.290). In this retrospective analysis of a large series of pediatric sickle cell ED visits, patients presented later in their VOC, and admission rate was higher than previously reported. A small proportion of older patients with SCD accounted for most ED visits and hospitalizations. Hgb variation from steady-state was neither clinically significant nor predictive of admission or discharge. In contrast to previous studies, receiving IVF in the ED was associated with a greater likelihood of discharge. Home opioids prior to ED presentation seemed to decrease hospital admission. Adherence to our center’s VOC protocol did not appear to influence disposition from the ED.

Survival disparity and racial differences in the use of neoadjuvant chemotherapy (NAC) compared with primary debulking surgery (PDS) in women with ovarian cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17099-e17099
Author(s):  
Eirwen M Miller ◽  
Joan Tymon-Rosario ◽  
Xianhong Xie ◽  
Harriet Olivia Smith ◽  
Gary L. Goldberg ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Racial Differences ◽  
Survival Data ◽  
Racial Disparity ◽  
Stage Iv ◽  
Stage Iii ◽  
Disease Stage ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Black Patients

e17099 Background: Studies demonstrate racial disparity in ovarian cancer survival though survival differences seem to be mitigated when patients receive similar care. We sought to identify whether racial disparity exists in the use of NAC or PDS for women with ovarian cancer. Methods: After IRB approval, all patients with epithelial ovarian cancer who received primary treatment at our institution from 2005-2016 were identified from our tumor registry. Charts were retrospectively reviewed for clinicopathologic and survival data. Categorical variables were compared with chi-squared and continuous variables with the student t-test. Kaplan-Meier was used to compare survival probabilities. Results: 302 evaluable patients were identified. 240 (79%) patients underwent PDS and 62 (21%) received NAC. Older patients, black patients, and those with stage III/IV disease were more likely to receive NAC. In a multivariate analysis controlling for stage and age, black race remained associated with NAC [OR 3.25 (95% CI 1.41-7.47), p < 0.01]. In a subgroup of advanced disease, stage III patients (n = 138) were more likely than stage IV patients (n = 52) to undergo PDS (78% v 44%, p < 0.01) and black patients were more likely than others to present with stage IV disease (39% v 22%, p = 0.01). NAC was utilized more frequently (48% v 24%, p < 0.01) in black patients compared with all other races. In the advanced stage subgroup analysis, patients that underwent PDS had a longer PFS than those that received NAC [HR 2.21 (95% CI 1.26-3.89), p = 0.01]. Conclusions: Racial disparity exists in the selection of PDS compared with NAC for patients with ovarian cancer and this disparity persists when controlling for stage and age. The choice of NAC or PDS may result in survival disparity. Further investigation is needed to examine other reasons, such as medical co-morbidities and disease distribution, for racial disparity in management. [Table: see text]

Does Modality of Adjuvant Chemotherapy After Interval Surgical Debulking Matter in Epithelial Ovarian Cancer?: An Exploratory Analysis

2014 ◽  
Vol 24 (3) ◽  
pp. 461-467 ◽  
Author(s):  
Nashmia Joudallah Al Mutairi ◽  
Tien Le
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Cox Regression ◽  
Group Versus ◽  
Progression Free Survival ◽  
Outcome Data ◽  
Categorical Variables ◽  
Surgical Debulking

ObjectivesThis article aimed to study the role of adjuvant intraperitoneal (IP) chemotherapy after neoadjuvant chemotherapy and optimal interval surgical debulking.MethodAll patients with epithelial ovarian cancer treated with neoadjuvant chemotherapy were retrospectively reviewed from 2007 to 2009. Demographics, related diseases, and survival outcome data were abstracted from the medical records. χ2statistics were applied to categorical variables. Cox regression was used to model progression-free survival (PFS), adjusting for age, residual status, and use of adjuvant IP chemotherapy. AllPvalues less than 0.05 were considered statistically significant.ResultsSixty-five patients were reviewed. The median age was 63.3 years. The majority had stage III disease with serous histology. Optimal residual (<1 cm) after interval debulking was achieved in 34 (54%) of 63 patients. Sixteen patients chose to receive adjuvant IP chemotherapy. The median follow-up was 26.2 months. Fifty-one patients had progressed, with a median PFS of 17.5 months. Adjuvant IP chemotherapy was not predictive of PFS (hazard ratio, 0.91; 95% confidence interval [CI], 0.24–3.44;P= 0.89). The estimated median overall survival was 37.8 months (95% CI, 29.9–45.7) in the intravenous group versus 48.1 months (95% CI, 37.9–58.3) in the IP-treated patients (P= 0.162).ConclusionsAdjuvant IP chemotherapy was not predictive of survival after neoadjuvant chemotherapy in our small exploratory study. The role of IP chemotherapy in this setting needs to be further studied in a larger prospective patient cohort.

Unraveling the high cost of end-of-life care: An oncology care model experience.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11534-11534 ◽  
Author(s):  
J. Russell Hoverman ◽  
Cynthia B. Taniguchi ◽  
Jad Hayes ◽  
Kathryn Eagye ◽  
B. Brooke Mann ◽  
...  
Keyword(s):  
End Of Life Care ◽  
Multivariate Regression ◽  
Claims Data ◽  
Hospice Care ◽  
Categorical Variables ◽  
Life Care ◽  
Care Model ◽  
Patient Demographics ◽  
Chi Squared ◽  
Oncology Care

11534 Background: Simply put, cancer care in the last 30 days of life (30DAY) is often aggressive and expensive without best meeting the wishes and needs of patients and caregivers. In this study, we evaluated total and 30DAY cost data for patients who died while enrolled from July 1, 2016 to June 30, 2017 in the Oncology Care Model (OCM), a Medicare (CMS) program initiated by the Center for Medicare and Medicaid Innovation. Methods: CMS provided claims data on 16 OCM-participating US Oncology Network practices. We measured 30DAY OCM episode expenditures (“EXP30”) for n = 5017 deceased patients, as well as patient demographics, clinical outcomes (hospital, ICU, and ER visits) and 30DAY treatments . The population was divided into two cohorts: those with ≥ 3 days of hospice care (“HC”) and those without (“NOHC”). EXP30 was compared between HC and NOHC at the univariate level using Wilcoxon Rank-sums; categorical variables were compared using Chi-squared tests. Multivariate regression was used to determine the effect of HC on EXP30 adjusted for demographic and disease factors. Results: HC had mean EXP30 reduction of $7,192 vs. NOHC [95%CI -$7,628, -$6,730] adjusted for demographics and disease. HC had lower rates of death in hospital (0.03% vs. 43.3%, p < .0001). Mean expense by days before death: NOHC values 0-30 days = $20,701; 31-60 days = $12,962; 61-90 days = $9,952 and HC values 0-30 days = $10,877; 31-60 days = $10,376; 61-90 days = $9,064. Conclusions: All categories of care except HC are associated with significantly higher cost in the last 30 days of life. The dramatic and steep trajectory in the last 30 days suggests high expense but also loss of choices as to how best to live the end of one’s life. The results will be updated as new data become available. [Table: see text]

scholarly journals Factors associated with involuntary admissions: a register-based cross-sectional multicenter study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
G. Maina ◽  
G. Rosso ◽  
C. Carezana ◽  
E. Mehanović ◽  
F. Risso ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Categorical Variables ◽  
Involuntary Admission ◽  
Continuous Variables ◽  
Treatment Rate ◽  
Cross Sectional ◽  
Mechanical Restraint ◽  
Admission Rates ◽  
Two Samples ◽  
Piedmont Region

Abstract Background Despite the EU recommendations on mental health, involuntary admission has been under researched in Italy for a long time and the overall picture of involuntary admission still appears fragmentary. The aims of this study are to evaluate involuntary admission rates in the Piedmont Region (Italy) and to investigate clinical and service-related variables associated with involuntary admission. Methods This is a cross-sectional retrospective multicenter study involving all psychiatric inpatients units of the general hospitals of Piedmont Region. Data on hospitalizations during 2016 were collected by consulting hospital discharge registers. The analyses were performed on two samples: 6018 patients (data analysis was run on first hospitalization during the study period for those with multiple admissions) and 7881 inpatient episodes. The association between involuntary admission and socio-demographic and clinical characteristics was examined through t-test for continuous variables, and Pearson’s Chi-square test for categorical variables. Multilevel modeling was applied in logistic regression models with two levels: for the first model center and participants and for the second model center and inpatient episodes. Results Of 6018 inpatients, 10.1% were admitted involuntarily at first hospitalization, while the overall compulsory treatment rate was slightly lower (9.1%) in the inpatient episodes sample (n = 7881). The involuntary admission rates ranged from 0.8 to 21% among study centers. Involuntary admissions were primarily associated with younger age, diagnosis of schizophrenia or substance use disorders, longer duration of hospital stay, mechanical restraint episodes, and fewer subsequent hospitalizations during the study period. Conclusions The rate of involuntary admission in the Piedmont Region was lower than the mean rate across countries worldwide. There were noteworthy differences in rates of involuntary admission among psychiatric units, although no relationship was found with characteristics of the psychiatric wards or of the areas where hospitals are located.

scholarly journals Practice Transformation: Early Impact of the Oncology Care Model on Hospital Admissions

2018 ◽  
Vol 14 (12) ◽  
pp. e739-e745 ◽  
Author(s):  
Molly A. Mendenhall ◽  
Karyn Dyehouse ◽  
Jad Hayes ◽  
Joanie Manzo ◽  
Teresa Meyer-Smith ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Average Cost ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Urgent Care ◽  
Inpatient Cost ◽  
Care Model ◽  
Hospital Admission Rate ◽  
Oncology Care ◽  
Cost Per Admission

Purpose: The purpose of the Oncology Care Model (OCM) is to improve quality and reduce cost through practice transformation. A foundational tenant is to reduce avoidable emergency room (ER) visits and hospitalizations. In anticipation of being an OCM participant, we instituted a multidimensional campaign designed to meet these objectives. Methods: Prior actions included establishment of phone triage unit, after-hours and weekend calls, and institution of weekend urgent care. Results: On the basis of data from the Chronic Condition Warehouse, as provided by the Centers for Medicare and Medicaid Services, we were successful at reducing the acute care admissions rate by 16%. During the baseline period extending from Jan 2016-Mar 2016, the hospital admission rate was 27 per patient, per quarter, at an average cost per admission event of $11,122, translating to an inpatient cost per patient, per quarter, of $3,003. In the year one reporting period of July 2016-July 2017, the hospital admission rate declined to 22.6 per patient, per quarter, at an average cost per admission event of $11,106, translating to an inpatient cost per patient, per quarter, of $2,505. OCM patient survey scores improved. In addition, at Oncology Hematology Care, we achieved improved results compared with the risk-adjusted national averages for the following measures: readmissions (4.9 v 5.6 per 100 patients, respectively), ER use (17 v 18.6 per 100 patients, respectively), and observation stays (2.7 v 3.6 per 100 patients, respectively). Conclusion: By implementing a cost-efficient, reproducible, and scalable campaign targeting ER avoidance and hospitalizations, we were able to decrease hospital admissions. Reported Medicare savings amounted to nearly $798,000 in inpatient cost per quarter over 1,600 patients.

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