Relationship of emergency department use pre- and post-cancer diagnosis in safety-net adults.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6626-6626
Author(s):  
Arthur Hong ◽  
Navid Sadeghi ◽  
John Vernon Cox ◽  
Simon Craddock Lee ◽  
Ethan Halm
Keyword(s):  
Emergency Department ◽  
Cancer Diagnosis ◽  
Initial Treatment ◽  
Safety Net ◽  
Urgent Care ◽  
Cancer Type ◽  
Advanced Stage ◽  
Seeking Behavior ◽  
Ed Visits ◽  
Advanced Stage Cancer

6626 Background: Safety-net adults generate a high rate of emergency department (ED) visits within the 180 days after a new cancer diagnosis, many of which could be alternatively triaged to an urgent care clinic. It is unclear how much of this ED use is attributable to the cancer and treatment vs. ED-seeking behavior. To identify patients at risk of frequent ED use, we explored whether a patient’s pre-cancer ED visit use predicted ED use after diagnosis. Methods: We identifiably linked adults from the tumor registry in the Dallas County safety-net health system to a regional hospital database with claims-like data for all patients from 98% of non-federal hospitals in North Texas. We applied a mixed-effects multivariate logit model, using frequent ED use (≥4 visits) in the 6-12 months or 12-18 months before diagnosis to predict frequent ED use after diagnosis, adjusting for demographics, comorbidities; cancer type, stage, initial treatment modalities; and grouping visits at the patient level. Results: Of 8,610 adults diagnosed from 2012-2016, 76.2% had Medicaid or were uninsured, 30.9% had lung, breast, or colorectal cancer, and 25.9% had advanced-stage cancer at diagnosis. In the 180 days after diagnosis, 42.5% of patients had zero ED visits, 45.7% had 1-3 visits, and 11.8% were frequent ED users (≥4). In multivariate analysis, patients with frequent ED use in the 6-12 months before a cancer diagnosis had 6.7 higher odds (95% CI: 4.8, 9.3) of having frequent ED use after diagnosis, compared to patients who had zero ED visits prior to diagnosis. This compared to 1.3 higher odds (95% CI: 1.1, 1.5) of frequent ED use if the patient had advanced-stage cancer, and 2.1 higher odds (95% CI: 1.8, 2.4) if chemotherapy was part of initial treatment. Although most post-diagnosis frequent ED users generated zero visits (62.2%) or 1-3 visits (30.7%) in the 6-12 months prior to diagnosis, 38% of patients with frequent ED use pre-diagnosis continued frequent ED visits after diagnosis. Results were similar for ED use 12-18 months prior to diagnosis. Conclusions: Among safety-net adults, prior ED-seeking behavior strongly predicted ED use after a new cancer diagnosis. This may represent a high-risk group that might benefit from care delivery innovation.

Prior Frequent Emergency Department Use as a Predictor of Emergency Department Visits After a New Cancer Diagnosis

2021 ◽  
pp. OP.20.00889
Author(s):  
Arthur S. Hong ◽  
Danh Q. Nguyen ◽  
Simon Craddock Lee ◽  
D. Mark Courtney ◽  
John W. Sweetenham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Diagnosis ◽  
Negative Binomial ◽  
Academic Medical Center ◽  
Safety Net ◽  
Emergency Department Visits ◽  
Patients With Cancer ◽  
Safety Net Hospital ◽  
Ed Visits ◽  
After Cancer

PURPOSE: To determine whether emergency department (ED) visit history prior to cancer diagnosis is associated with ED visit volume after cancer diagnosis. METHODS: This was a retrospective cohort study of adults (≥ 18 years) with an incident cancer diagnosis (excluding nonmelanoma skin cancers or leukemia) at an academic medical center between 2008 and 2018 and a safety-net hospital between 2012 and 2016. Our primary outcome was the number of ED visits in the first 6 months after cancer diagnosis, modeled using a multivariable negative binomial regression accounting for ED visit history in the 6-12 months preceding cancer diagnosis, electronic health record proxy social determinants of health, and clinical cancer-related characteristics. RESULTS: Among 35,090 patients with cancer (49% female and 50% non-White), 57% had ≥ 1 ED visit in the 6 months immediately following cancer diagnosis and 20% had ≥ 1 ED visit in the 6-12 months prior to cancer diagnosis. The strongest predictor of postdiagnosis ED visits was frequent (≥ 4) prediagnosis ED visits (adjusted incidence rate ratio [aIRR]: 3.68; 95% CI, 3.36 to 4.02). Other covariates associated with greater postdiagnosis ED use included having 1-3 prediagnosis ED visits (aIRR: 1.32; 95% CI, 1.28 to 1.36), Hispanic (aIRR: 1.12; 95% CI, 1.07 to 1.17) and Black (aIRR: 1.21; 95% CI, 1.17 to 1.25) race, homelessness (aIRR: 1.95; 95% CI, 1.73 to 2.20), advanced-stage cancer (aIRR: 1.30; 95% CI, 1.26 to 1.35), and treatment regimens including chemotherapy (aIRR: 1.44; 95% CI, 1.40 to 1.48). CONCLUSION: The strongest independent predictor for ED use after a new cancer diagnosis was frequent ED visits before cancer diagnosis. Efforts to reduce potentially avoidable ED visits among patients with cancer should consider educational initiatives that target heavy prior ED users and offer them alternative ways to seek urgent medical care.

scholarly journals Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System

2019 ◽  
Vol 15 (6) ◽  
pp. e490-e500 ◽  
Author(s):  
Arthur S. Hong ◽  
Navid Sadeghi ◽  
Valorie Harvey ◽  
Simon Craddock Lee ◽  
Ethan A. Halm
Keyword(s):  
Emergency Department ◽  
Health System ◽  
Safety Net ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Newly Diagnosed ◽  
Care Clinic ◽  
Medication Refill ◽  
Urban Safety ◽  
Ed Visits

PURPOSE: There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. PATIENTS AND METHODS: This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. RESULTS: The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). CONCLUSION: ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.

Are ED visits in cancer patients preventable? Care patterns before an ED visit.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2023-2023
Author(s):  
Arthur Hong ◽  
Hannah Fullington ◽  
Navid Sadeghi ◽  
John V. Cox ◽  
Stephanie Clayton Hobbs ◽  
...  
Keyword(s):  
Cancer Diagnosis ◽  
Information Exchange ◽  
Severity Of Illness ◽  
Safety Net ◽  
Urgent Care ◽  
Secure Messaging ◽  
Outpatient Visits ◽  
Ed Visits ◽  
After Cancer ◽  
Clinic Visits

2023 Background: Medicare’s Oncology Care Model alternative payment program participation requires 24-hr patient access to clinician phone advice. Many participating practices have established oncology urgent care clinics to reduce the frequent ED visits in the early phase after cancer diagnosis. However, little is known about patients’ use of pre-ED visit clinical advice via phone. We combined EHR data on phone/secure messaging encounters, outpatient visits, and regional ED visits, to assess how often patients visit the ED without prior clinical advice, and to compare ED visit severity between those with and without preceding clinical advice. Methods: We linked adults ages 18+ from Parkland Health and Hospital System (PHHS), the Dallas County public safety net system, and UT Southwestern (UTSW) NACR Gold-certified cancer registry (2012-2018), to their respective EHR, and identifiably linked patients to a regional health information exchange of ED and hospital encounters. Exchange data included hospital name, ED disposition, diagnoses, and ED Severity Of Illness. We tallied ED visits within 6 months (180 days) after cancer diagnosis and EHR clinical contacts for 24 hours prior to ED visit (telephone/secure messaging, outpatient visits). After descriptive statistics, we used mixed-effects multivariate logistic regression clustering at patient level to model ED disposition after a pre-ED clinical contact. Results: We matched 8,289 Parkland (54% female, 78% Medicaid/charity assistance) and 10,817 UTSW patients (50% female, 12% Medicaid), who generated 21,009 and 22,696 ED visits, respectively. Two-thirds of all ED visits occurred without preceding clinical contact (70.2% PHHS, 66.7% UTSW); large shares of ED visits were to 67 other regional hospitals (22.2% PHHS, 69.5% UTSW). Telephone encounters and outpatient visits to any specialty were the most common contact before ED visit (UTSW: 28.2 and 12.4%; PHHS: 8.7 and 16.1%), but while nearly all UTSW clinic visits were to oncology, only 30% of PHHS clinic visits were to oncology. Though ED visit severity was slightly higher for ED visits without preceding clinical contact (46% vs. 43% ≥Major severity, p < 0.01), patients were discharged home more often if clinical contact preceded ED visits (aOR of hospitalization 0.82, 95% CI: 0.74 – 0.90). Conclusions: Two-thirds of ED visits occurred without prior clinical contact, and though these no-contact ED visits had higher severity of illness, they were more often discharged home from the ED. Future work should identify patient-oriented options to optimize the use of clinical care and the ED.

Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data

2021 ◽  
pp. bmjqs-2020-012898
Author(s):  
Rie Sakai-Bizmark ◽  
Hiraku Kumamaru ◽  
Dennys Estevez ◽  
Sophia Neman ◽  
Lauren E M Bedel ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Random Effect ◽  
Safety Net ◽  
Homeless Women ◽  
Homeless Population ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Ed Visits ◽  
Income Quartile

ObjectiveTo assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women.DesignCross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect.SettingNew York statewide inpatient and emergency department databases (2009–2014).Participants82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.Main outcome measuresPostpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation.ResultsHomeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased.ConclusionsTwo factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.

Incidence and characteristics of emergency department presentations during immune checkpoint inhibitor therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14164-e14164
Author(s):  
Daniel Arnold Smith ◽  
Kai Laukamp ◽  
Melanie Campbell ◽  
Robert Devita ◽  
Ariel Ann Nelson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Overall Survival ◽  
Anticancer Agents ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Demographic Data ◽  
Cancer Type ◽  
Primary Cancer ◽  
Oncology Patients ◽  
Ed Visits

e14164 Background: Immune checkpoint inhibitors (ICIs) have emerged as a novel class of anticancer agents with unique response and toxicity profiles. Oncology patients undergoing ICI therapy can present acutely with cancer- or treatment-related complications, but knowledge of these acute clinical presentations is limited. The objective of this study was to investigate the features of emergency department (ED) presentations of patients undergoing ICI therapy. Methods: A retrospective chart review was performed of 1044 adult oncology patients at a single institution from 2010-2018 who underwent treatment with one or more ICI. The number of patient visits to the ED during and up to one month following ICI treatment was recorded, in addition to various clinical and demographic data. These data were compared based on stratification by number of ED visits (0 visits, 1 visit, or ≥2 visits) using Likelihood Ratio Chi-Square and Mann–Whitney U tests. Results: Mean age for the 1044 patients receiving ICI therapy was 64±13 years, with 57% males and 43% females. Primary cancer distribution included 42.0% lung, 24.2% melanoma, 6.9% head & neck, 5.1% kidney, 4.0% bladder, and 17.8% other malignancy. 83.4% of patients were treated with a single ICI, 14.9% with 2 ICIs, and 1.2% with 3-4 ICIs. 56.0% of patients had no ED visits during their treatment duration, 27.0% had 1 ED visit, and 17.0% had ≥2 ED visits. Patients with lung, kidney, and bladder cancer were more likely to present to the ED (p = < 0.001). Black ethnicity was the only demographic feature associated with more ED visits (p = 0.017). Patients receiving ≥2 ICIs or monotherapy with nivolumab, pembrolizumab, or atezolizumab more frequently presented to the ED compared to other ICIs (p = < 0.001). Patients with 1 or ≥2 ED visits had longer durations of ICI therapy (136±12 days and 216±15 days, respectively) compared to patients with no ED visits (127±8 days) (p = < 0.001). Patients with no ED visits also demonstrated better overall survival (p = < 0.001). Conclusions: More frequent ED visits during ICI therapy is statistically associated with several key clinical factors, including primary cancer type, ethnicity, specific ICI agent, ICI therapy duration, and overall survival.

Patterns and Results of Triage Advice Before Emergency Department Visits Made by Patients With Cancer

2021 ◽  
pp. OP.20.00617
Author(s):  
Arthur S. Hong ◽  
Hannah Chang ◽  
D. Mark Courtney ◽  
Hannah Fullington ◽  
Simon J. Craddock Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Urgent Care ◽  
Telephone Triage ◽  
Patients With Cancer ◽  
Oncology Care ◽  
Ed Visits ◽  
The University

PURPOSE: Patients with cancer undergoing treatment frequently visit the emergency department (ED) for commonly anticipated complaints (eg, pain, nausea, and vomiting). Nearly all Medicare Oncology Care Model (OCM) participants prioritized ED use reduction, and the OCM requires that patients have 24-hour telephone access to a clinician, but actual reductions in ED visits have been mixed. Little is known about the use of telephone triage for acute care. METHODS: We identified adults aged 18+ years newly diagnosed with cancer, linked to ED visits from a single institution within 6 months after diagnosis, and then analyzed the telephone and secure electronic messages in the preceding 24 hours. We coded interactions to classify the reason for the call, the main ED referrer, and other attempted management. We compared the acuity of patient self-referred versus clinician-referred ED visits by modeling hospitalization and ED visit severity. RESULTS: From 2011 to 2018, 3,247 adults made 5,371 ED visits to the university hospital and self-referred to the ED 58.5% of the time. Clinicians referred to outpatient or oncology urgent care for 10.3% of calls but referred to the ED for 61.3%. Patient self-referred ED visits were likely to be hospitalized (adjusted Odds Ratio [aOR], 0.89, 95% CI, 0.64 to 1.22) and were not more severe (aOR, 0.75, 95% CI, 0.55 to 1.02) than clinician referred. CONCLUSION: Although patients self-referred for six of every 10 ED visits, self-referred visits were not more severe. When patients called for advice, clinicians regularly recommended the ED. More should be done to understand barriers that patients and clinicians experience when trying to access non-ED acute care.

scholarly journals First and Second Wave Dynamics of Emergency Department Utilization during the COVID-19 Pandemic: a retrospective study

2021 ◽  
Author(s):  
Robi Dijk ◽  
Patricia Plaum ◽  
Stan Tummers ◽  
Frits van Osch ◽  
Dennis Barten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Reference Period ◽  
Wave Dynamics ◽  
Admission Rates ◽  
High Urgency ◽  
Ed Visits ◽  
Second Wave ◽  
Insight Into

Background: Since the COVID-19 pandemic, there has been a decrease in emergency department(ED) utilization. Although this has been thoroughly characterized for the first wave(FW), studies during the second wave(SW) are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods. Methods: We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March until June and September until December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non)COVID suspected. Findings: During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID related visits were significantly more often in higher need of urgent care and ARs where at least 24.0% higher compared to non COVID visits. Interpretation: During both COVID-19 waves ED visits were significantly reduced, with the most distinct decline during the FW. ED patients were more often triaged as high urgent and the ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. These findings indicate the need to gain more insight into motives of patients to delay or avoid emergency care during pandemics and prepare EDs for future pandemics.

scholarly journals Emergency department utilization for substance use disorders and mental health conditions during COVID-19

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262136
Author(s):  
Arjun K. Venkatesh ◽  
Alexander T. Janke ◽  
Jeremy Kinsman ◽  
Craig Rothenberg ◽  
Pawan Goyal ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Substance Use ◽  
Safety Net ◽  
Health Conditions ◽  
Emergency Department Utilization ◽  
Mental Health Conditions ◽  
Ed Visits ◽  
National Emergency

Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.

Safety and outcomes of a cancer patient urgent care clinic.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6542-6542
Author(s):  
Jack S Bevins ◽  
Hannah Fullington ◽  
Thomas W. Froehlich ◽  
Stephanie Hobbs ◽  
Ethan Halm ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Urgent Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Inpatient Hospitalization ◽  
Care Clinic ◽  
Chief Complaints ◽  
Ed Visits ◽  
Urgent Care Clinic ◽  
Advanced Stage Cancer

6542 Background: Several cancer centers describe cancer-patient dedicated urgent care clinic (UCC) that address commonly anticipated complaints of adults with cancer. UCC may be capable of preventing some ED visits, but little is known of the safety and outcomes for patients after a UCC visit. Methods: We identified UCC visits made by adults at our comprehensive cancer center between 2013-2016 and compared the cohort to patients who did not visit the UCC. We linked patients to tumor registry data and their electronic health record from the UCC visit, then tracked ED visits, inpatient and intensive care unit (ICU) admissions occurring within 24 hours of the UCC visit. Results: Between 2013-2016, 551 patients generated 772 UCC visits, compared to 17,496 who did not visit. UCC users had significantly (p<0.001) more advanced-stage cancer than non-UCC users (37.3% vs 18.9%), but there were no significant differences in mean age, race/ethnicity, or death within 180 days of diagnosis. The most common chief complaints accounted for nearly half of all UCC visits: (17.4%), URI symptoms/fever (12.6%), nausea/vomiting/diarrhea (7.8%), and fatigue/weakness (7.6%). After 10.0% of UCC visits, patients had an ED visit, while 12.3% were admitted to the hospital; only 5 UCC visits (0.7%) had an associated ICU stay. Most patients (75.7%) only had a single UCC visit, but patients who visited the UCC more often tended to have higher rates of ED visits and hospitalizations within 24 hours (Table). The mean time from UCC arrival to ED arrival was 3.0 hours, and 6.5 hours from UCC arrival to inpatient arrival. Conclusions: The majority of patients seen in UCC did not require ED or inpatient hospitalization. Patients with subsequent ED or inpatient visits had minimal delays in care. Findings suggest that triaging cancer patients for commonly anticipated complaints to a UCC does not result in high rates of mis-triaging or major delays in care. Patients with ED, Inpatient, or ICU visit after UCC, stratified by UCC visits per patient (2013-2016). [Table: see text]

scholarly journals Effect of Insurance Status on the Stage of Breast and Colorectal Cancers in a Safety-Net Hospital

2012 ◽  
Vol 8 (3S) ◽  
pp. 16s-21s ◽  
Author(s):  
Daniel T. Farkas ◽  
Arieh Greenbaum ◽  
Vinay Singhal ◽  
John M. Cosgrove
Keyword(s):  
Advanced Disease ◽  
Safety Net ◽  
Colorectal Cancers ◽  
Insurance Status ◽  
Advanced Stage ◽  
Safety Net Hospital ◽  
Hospital Patients ◽  
Advanced Stage Cancer

In a safety-net hospital, patients with Medicaid have rates of advanced-stage cancer similar to those of patients with other types of insurance; however, patients with no insurance have significantly higher rates of advanced disease.

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