Functional impairment on admission and associated symptom burden and health outcomes among hospitalized patients with advanced cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11554-11554
Author(s):  
Daniel E Lage ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Richard Newcomb ◽  
Vicki Jackson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Health Outcomes ◽  
Advanced Cancer ◽  
Functional Impairment ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Comorbidity Index ◽  
The Relationship

11554 Background: Hospitalized patients with cancer often have impaired function, as measured by activities of daily living (ADLs), related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between functional impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment on admission and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (Mean = 67.2 vs 60.8 years, p < 0.001), had higher Charlson comorbidity index (Mean = 1.1 vs 0.7, p < 0.001), and higher physical symptom burden (ESAS Physical Mean = 35.2 vs 30.9, p < 0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p < 0.01), pain (74.9% vs. 63.1%, p < 0.01), drowsiness (76.6% vs. 68.3%, p < 0.01), as well as symptoms of depression (38.3% vs. 23.6%, p < 0.01) and anxiety (35.9% vs. 22.4%, p < 0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B = 1.30, p < 0.01), higher odds of death or readmission within 90 days (odds ratio = 2.26, p < 0.01), and higher mortality (hazard ratio = 1.73, p < 0.01). Conclusions: Hospitalized patients with advanced cancer who have functional impairment experience a significantly higher symptom burden and worse health outcomes compared to those without functional impairment. These findings highlight the need to assess and address functional impairment among this population to enhance their quality of life and care.

Association of impairments in activities of daily living (ADLs) with symptom burden, health care utilization, and survival among hospitalized patients with advanced cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 203-203
Author(s):  
Daniel E Lage ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Richard Newcomb ◽  
Vicki Jackson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Advanced Cancer ◽  
Charlson Comorbidity Index ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Cancer Type ◽  
Comorbidity Index ◽  
The Relationship

203 Background: Hospitalized patients with cancer often have impaired ADLs related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between ADL impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (67.2 vs. 60.8 years, p<0.001), had higher Charlson comorbidity index (1.1 vs. 0.7, p<0.001), and higher physical symptom burden (ESAS Physical 35.2 vs. 30.9, p<0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p<0.01), pain (74.9% vs. 63.1%, p<0.01), drowsiness (76.6% vs. 68.3%, p<0.01), as well as symptoms of depression (38.3% vs. 23.6%, p<0.01) and anxiety (35.9% vs. 22.4%, p<0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B=1.30, p<0.01), higher odds of death or readmission within 90 days (odds ratio=2.26, p<0.01), and worse survival (hazard ratio=1.73, p<0.01). Conclusions: Hospitalized patients with advanced cancer who have ADL impairment experience a significantly higher symptom burden and worse health outcomes compared to those without ADL impairment. These findings highlight the need to assess and address ADL impairment among this population to enhance their quality of life and care.

scholarly journals Functional Impairment, Symptom Burden, and Clinical Outcomes Among Hospitalized Patients With Advanced Cancer

2020 ◽  
Vol 18 (6) ◽  
pp. 747-754 ◽  
Author(s):  
Daniel E. Lage ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Richard A. Newcomb ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Functional Status ◽  
Clinical Outcomes ◽  
Advanced Cancer ◽  
Functional Impairment ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Hospital Length Of Stay

Background: National guidelines recommend regular measurement of functional status among patients with cancer, particularly those who are elderly or high-risk, but little is known about how functional status relates to clinical outcomes among hospitalized patients with advanced cancer. The goal of this study was to investigate how functional impairment is associated with symptom burden and healthcare utilization and clinical outcomes. Patients and Methods: We conducted a prospective observational study of patients with advanced cancer with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Upon admission, nurses assessed patients’ activities of daily living (ADLs; mobility, feeding, bathing, dressing, and grooming). Patients with any ADL impairment on admission were classified as having functional impairment. We used the revised Edmonton Symptom Assessment System (ESAS-r) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. Multivariable regression models were used to assess the relationships between functional impairment, hospital length of stay, and survival. Results: Among 971 patients, 390 (40.2%) had functional impairment. Those with functional impairment were older (mean age, 67.18 vs 60.81 years; P<.001) and had a higher physical symptom burden (mean ESAS physical score, 35.29 vs 30.85; P<.001) compared with those with no functional impairment. They were also more likely to report moderate-to-severe pain (74.9% vs 63.1%; P<.001) and symptoms of depression (38.3% vs 23.6%; P<.001) and anxiety (35.9% vs 22.4%; P<.001). Functional impairment was associated with longer hospital length of stay (β = 1.29; P<.001) and worse survival (hazard ratio, 1.73; P<.001). Conclusions: Hospitalized patients with advanced cancer who had functional impairment experienced a significantly higher symptom burden and worse clinical outcomes compared with those without functional impairment. These findings provide evidence supporting the routine assessment of functional status on hospital admission and using this to inform discharge planning, discussions about prognosis, and the development of interventions addressing patients’ symptoms and physical function.

scholarly journals Associations of Skeletal Muscle With Symptom Burden and Clinical Outcomes in Hospitalized Patients With Advanced Cancer

2021 ◽  
Vol 19 (3) ◽  
pp. 319-327
Author(s):  
Emily van Seventer ◽  
J. Peter Marquardt ◽  
Amelie S. Troschel ◽  
Till D. Best ◽  
Nora Horick ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Muscle Mass ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hazard Ratio ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Muscle Quality ◽  
Healthcare Use

Background: Low muscle mass (quantity) is common in patients with advanced cancer, but little is known about muscle radiodensity (quality). We sought to describe the associations of muscle mass and radiodensity with symptom burden, healthcare use, and survival in hospitalized patients with advanced cancer. Methods: We prospectively enrolled hospitalized patients with advanced cancer from September 2014 through May 2016. Upon admission, patients reported their physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used CT scans performed per routine care within 45 days before enrollment to evaluate muscle mass and radiodensity. We used regression models to examine associations of muscle mass and radiodensity with patients’ symptom burden, healthcare use (hospital length of stay and readmissions), and survival. Results: Of 1,121 patients enrolled, 677 had evaluable muscle data on CT (mean age, 62.86 ± 12.95 years; 51.1% female). Older age and female sex were associated with lower muscle mass (age: B, –0.16; P<.001; female: B, –6.89; P<.001) and radiodensity (age: B, –0.33; P<.001; female: B, –1.66; P=.014), and higher BMI was associated with higher muscle mass (B, 0.58; P<.001) and lower radiodensity (B, –0.61; P<.001). Higher muscle mass was significantly associated with improved survival (hazard ratio, 0.97; P<.001). Notably, higher muscle radiodensity was significantly associated with lower ESAS-Physical (B, –0.17; P=.016), ESAS-Total (B, –0.29; P=.002), PHQ-4-Depression (B, –0.03; P=.006), and PHQ-4-Anxiety (B, –0.03; P=.008) symptoms, as well as decreased hospital length of stay (B, –0.07; P=.005), risk of readmission or death in 90 days (odds ratio, 0.97; P<.001), and improved survival (hazard ratio, 0.97; P<.001). Conclusions: Although muscle mass (quantity) only correlated with survival, we found that muscle radiodensity (quality) was associated with patients’ symptoms, healthcare use, and survival. These findings underscore the added importance of assessing muscle quality when seeking to address adverse muscle changes in oncology.

scholarly journals Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer

2018 ◽  
Vol 24 (1) ◽  
pp. 117-124 ◽  
Author(s):  
Risa L. Wong ◽  
Areej El‐Jawahri ◽  
Sara M. D'Arpino ◽  
Charn‐Xin Fuh ◽  
P. Connor Johnson ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Length Of Stay ◽  
Advanced Cancer ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Antidepressant Medications ◽  
The Relationship

Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 180-180
Author(s):  
Carolyn L. Qian ◽  
Charu Vyas ◽  
Eva Gaufberg ◽  
Emilia Kaslow-Zieve ◽  
Chinenye C. Azoba ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Care Coordination ◽  
Symptom Burden ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Satisfaction With Care ◽  
Patients With Cancer ◽  
Oncology Service ◽  
Care Satisfaction

180 Background: Hospitalized patients with cancer often experience a high symptom burden, which may impact care satisfaction and healthcare utilization. However, research describing these patients’ care satisfaction, symptom burden, and health care use is lacking. We sought to investigate relationships among care satisfaction, physical and psychological symptom burden, and hospital length of stay (LOS) in hospitalized patients with cancer. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014 to 4/2017. Upon admission, we assessed patients’ care satisfaction (FAMCARE items: satisfaction with care coordination and the speed with which symptoms are treated) as well as their physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used regression models to identify factors associated with care satisfaction, and we also examined associations of care satisfaction with patients’ symptom burden and hospital length of stay (LOS). Results: Among 1,576 participants (median age = 65.0 years [range:19-96], 46.3% female, 70.9% with incurable cancer, 58.4% admitted to a dedicated oncology service), most reported being “satisfied” or “very satisfied” with care coordination (90.1%) and the speed with which symptoms are treated (89.0%). Older age (care coordination: B < 0.01, P = 0.022, speed with which symptoms are treated: B = 0.01, P = 0.001) and admission to a dedicated oncology service (B = 0.20, P < 0.001 for each) were associated with higher care satisfaction. Higher satisfaction with care coordination was associated with lower ESAS-physical (B = -1.28, P = 0.007), ESAS-total (B = -2.73, P < 0.001), PHQ4-depression (B = -0.14, P = 0.022), and PHQ4-anxiety (B = -0.16, P = 0.008) symptoms. Higher satisfaction with the speed with which symptoms are treated was associated with lower ESAS-physical (B = -1.32, P = 0.003), ESAS-total (B = -2.46, P < 0.001), PHQ4-depression (B = -0.14, P = 0.014), and PHQ4-anxiety (B = -0.17, P = 0.004) symptoms. Greater satisfaction with care coordination (B = -0.48, P = 0.040) and the speed with which symptoms are treated (B = -0.44, P = 0.041) were both associated with shorter LOS. Conclusions: Hospitalized patients with cancer report high care satisfaction, which correlates with older age and admission to a dedicated oncology service. Significant associations among higher care satisfaction, lower symptom burden, and shorter hospital LOS highlight the importance of improving symptom management and care coordination in this population.

Symptom burden and hospital length of stay among patients with curable cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6579-6579
Author(s):  
Sara D'Arpino ◽  
Areej El-Jawahri ◽  
Samantha M.C. Moran ◽  
Connor Johnson ◽  
Daniel Lage ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
Psychological Symptoms ◽  
Symptom Burden ◽  
Hospital Length ◽  
Assessment System ◽  
Hospital Length Of Stay ◽  
Cancer Type ◽  
Unplanned Hospital Admissions ◽  
The Relationship

6579 Background: Prolonged hospital admissions are often inconsistent with patients’ preferences and incur significant costs. While patients’ symptoms may result in hospitalizations, the relationship between patients’ symptom burden and their hospital length-of-stay (LOS) has not been fully explored in patients with curable cancers. Methods: We prospectively enrolled patients with curable cancer and unplanned hospital admissions between 8/2015 and 12/2016. Within the first 5 days of admission, we assessed patients’ physical (Edmonton Symptom Assessment System [ESAS]; scored 0-10 with higher scores indicating greater symptom burden) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]; scored categorically and continuous with higher scores indicating greater distress). We created summated ESAS total and physical symptom variables. To assess the relationship between patients’ symptom burden and their hospital LOS, we used separate linear regression models adjusted for age, sex, marital status, education level, time since cancer diagnosis, and cancer type. Results: We enrolled 452 of 497 (91%) approached patients (mean age = 61.9 years; 188 [42%] female). Over half had hematologic cancers (n = 249, 55%). Mean hospital LOS was 8.3 days. Over one-tenth of patients screened positive for PHQ-4 depression (n = 74, 16%) and anxiety (n = 60, 13%) symptoms. Mean ESAS symptom scores were highest for fatigue (6.6), drowsiness (5.4), pain (4.9), and lack of appetite (4.8). In multivariable regression analysis, patients’ physical and psychological symptoms were associated with longer hospital LOS (table). Conclusions: Patients with curable cancer and unplanned hospital admissions experience a substantial symptom burden, which predicts for prolonged hospitalizations. Importantly, patients’ symptoms are modifiable risk factors that, if properly addressed, can improve care delivery and may have the potential to help decrease prolonged hospitalizations. [Table: see text]

Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

2017 ◽  
Vol 71 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Emilia Gómez-Hoyos ◽  
Martín Cuesta ◽  
Nayade Del Prado-González ◽  
Pilar Matía ◽  
Natalia Pérez-Ferre ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Mortality Rate ◽  
Parenteral Nutrition ◽  
Demographic Data ◽  
Tertiary Hospital ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Control Subjects ◽  
Comorbidity Index

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

scholarly journals 562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S346-S346
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
David Reeves ◽  
Christian Cheatham
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Fungal Infections ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Matched Design ◽  
Median Hospital

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin &gt; 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer &gt; 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Symptom burden, functional status, and clinical outcomes of hospitalized patients with advanced genitourinary cancers.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 42-42
Author(s):  
Daniel E Lage ◽  
M Dror Michaelson ◽  
Christopher Sweeney ◽  
Erika D. Barrett ◽  
Kara Marie Olivier ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Functional Status ◽  
Advanced Cancer ◽  
Cancer Diagnosis ◽  
Functional Impairment ◽  
Symptom Management ◽  
Symptom Burden ◽  
Hospitalized Patients ◽  
Adrenal Cancer ◽  
Cancer Types

42 Background: Patients with advanced genitourinary (GU) cancers are often hospitalized for complications of their cancer and symptom management. Yet, little is known about the symptom burden, functional status, and health care utilization of these patients. Methods: We prospectively enrolled patients with advanced cancer who experienced unplanned hospitalizations at an academic medical center. Upon admission, we asked patients to self-report their physical (Edmonton Symptom Assessment Scale-revised [ESAS-r]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We also collected data from nursing assessments about impairments in activities of daily living (ADLs). We compared symptoms, functional impairment, readmissions, and overall survival (OS) between cancer types (dichotomizing GU cancers vs other cancer types) and within GU cancers (dichotomizing prostate cancer vs kidney/bladder/adrenal cancer) using univariate and multivariable regression analyses adjusted for age, sex, education, comorbidities, and time since advanced cancer diagnosis. Results: Among 971 patients enrolled, 106 (10.9%) had advanced GU cancers (39.6% prostate cancer, 32.1% kidney cancer, 25.5% bladder cancer, and 2.8% adrenal cancer). Compared to patients with other cancer types, patients with GU cancers were older (median: 69.0 vs 64.0 years, p < 0.001) and had more time since advanced cancer diagnosis (median: 14.0 vs 7.0 months, p < 0.001). In univariate analyses, a greater proportion of patients with GU cancers had an ADL impairment (57.5% vs 38.0%, p < 0.001) compared to other cancer types but the groups did not differ in their physical (Mean = 33.3 vs 32.6, p = 0.61) or depression (Mean = 4.1 vs 3.3, p = 0.05) symptoms. In multivariable models, patients with GU cancers had similar risk of readmission in 90 days (HR 1.31, p = 0.077), but worse survival (median OS: 102.0 days vs 133.5 days, p < 0.001; HR 1.27, p = 0.046). Within GU cancers, patients with kidney/bladder/adrenal cancer (vs. prostate cancer) were younger (median: 66.0 vs 74.0, p < 0.001) with less time since advanced cancer diagnosis (median: 9.0 vs 23.0 months, p = 0.012) but had no difference in symptoms or functional impairment. They were more likely to be admitted for symptom management (66% vs. 39% for prostate cancer, p = 0.026). Patients with kidney/bladder/adrenal cancer also had higher risk of readmission (HR 2.04, p = 0.043) but no difference in OS, compared to patients with prostate cancer. Conclusions: We found that hospitalized patients with advanced GU cancers had significantly greater functional impairment and worse survival compared to those with other cancer types, and those with kidney/bladder/adrenal cancer had significantly higher readmission risk compared to those with prostate cancer. These findings support the need to develop tailored supportive care for hospitalized patients with GU cancers.

scholarly journals Association between Insurance Status and Hospital Length of Stay following Trauma

2016 ◽  
Vol 82 (3) ◽  
pp. 281-288 ◽  
Author(s):  
Brian R. Englum ◽  
Xuan Hui ◽  
Cheryl K. Zogg ◽  
Muhammad Ali Chaudhary ◽  
Cassandra Villegas ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Trauma Patients ◽  
Uninsured Patients ◽  
National Trauma ◽  
Insured Patients ◽  
The Relationship

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

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