Impact of an oncology acute care clinic (ACC) in a comprehensive cancer care setting to reduce emergency visits and subsequent hospitalizations: A pilot study.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 110-110
Author(s):  
Anamika Chaudhuri ◽  
Andrew J. Wagner ◽  
Craig A. Bunnell ◽  
Anne Gross ◽  
Emma Green ◽  
...  
Keyword(s):  
Acute Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Urgent Care ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Emergency Visits ◽  
Care Clinic ◽  
Discharge Disposition ◽  
Ed Visits

110 Background: Emergency Department (ED) visits and subsequent hospitalizations are a major source of healthcare resource utilization and costs among cancer patients, compromising quality of care and patient satisfaction. Emerging evidence, including OCM and other alternative payment models suggest many of these visits may be preventable and effectively managed in oncology-specific urgent care clinics. Little is known about such care delivery models in the comprehensive cancer care arena. Methods: As part of larger effort to provide better, efficient, timely care to patients, an acute care clinic (ACC), appropriately staffed to provide ancillary services, was set up in an academic hospital outpatient setting with hours of operations 10:30- 8:00 pm to effectively manage patients with cancer-related symptoms. The objective was to change the site of care for patients who would otherwise be seen in the ED and discharged home as well as to potentially decrease the frequency of hospitalization following ED evaluation by providing oncology subspecialized care. A retrospective analysis of 4 months pre- and post-intervention was performed with emergency visits per 1000 visits per month as the primary outcome and subsequent hospitalizations as a secondary outcome. Results: A total of 1593 patients (821 pre-intervention and 772 post-intervention) were included. Preliminary analysis revealed a 7% observed reduction in ED visits (0.25 vs 0.23 visits per month per 1000 visits; p = 0.85) for oncology patients which otherwise would have seen a 12% increase, following the historical trend. Data also suggest more effective avoidance of acute care settings with discharge disposition for patients from ED pre-intervention versus ACC post-intervention being 32% vs 72% home, 67% vs 13% inpatient, 1% vs 6% ED respectively. Conclusions: The creation of an ACC to manage urgent patient visits in an ambulatory setting decreased ED visits and the likelihood of patient admission. Although initial findings suggest improved preliminary outcomes, further analysis is required to make any causal inference on the true impact of ACC intervention for reduction of ED and hospitalizations.

A solution to reducing avoidable emergency department visits: Implementation of an outpatient oncology acute care clinic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13517-e13517
Author(s):  
Sadaf Charania ◽  
Judy Devlin ◽  
Edie Brucker ◽  
Shayna Simon ◽  
Christine Hong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cancer Treatment ◽  
Acute Care ◽  
The United States ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Outpatient Basis ◽  
Oncology Patients ◽  
Care Clinic ◽  
Ed Visits

e13517 Background: Emergency Department (ED) utilization by oncology patients accounts for more than 4.5 million visits in the United States annually, leading to hospitalization four times the rate of the general population.1,2 Many ED visits are the result of symptoms related to cancer or cancer treatment that can be managed on an outpatient basis. Unnecessary admissions lead to possible delays in cancer treatment and increased burden on healthcare resources.3 Simmons Acute Care (SAC), an advanced practice provider (APP)-led clinic, was established in August 2020 to provide an alternative model of oncology care to address these issues. Methods: A multidisciplinary team of key stakeholders was formed to develop an action plan. Institutional data was reviewed to identify the timing and volume of ED visits by oncology patients. Clinic hours were set Monday through Friday, 7:00am – 7:00pm, and referrals were made from primary oncology providers. Evidence-based clinical pathways were developed to standardize patient management, and a data collection plan was implemented to measure outcomes. Internal communications to patients and presentations at staff and faculty meetings occurred to inform patients and clinical staff/providers. Results: From August to December 2020, 165 patient visits were completed in SAC, 141 patients discharged home, 14 patients directly admitted to the hospital, and 10 patients transferred to the ED for a higher level of care. Based on data from 2020, the average cost of an ED visit for an oncology patient was $5,500 and increased to $28,500 if the patient is admitted. Patients with hematologic and gastrointestinal malignancies represented approximately 30% of all visits. Gastrointestinal symptoms were the most frequent presenting chief complaint. Conclusions: Supporting oncology patients in the ambulatory setting provided a reduction in admissions and unnecessary ED visits, leading to cost savings/avoidance to the patient and health system. Based on internal cost analyses, there are potential savings of over $2 million to the organization during this 5-month period. Additional studies are underway to assess patient satisfaction, as well as the economic impact for patients. 1. Rui PKK. National Hospital Ambulatory Medical Care Survey: 2015 emergency department summary tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf 2. Hong AS, Froehlich T, Clayton Hobbs S, Lee SJC, Halm EA. Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits. J Oncol Pract. 2019;15(6):e501-e509. doi:10.1200/JOP.18.00743 3. Roy M, Halbert B, Devlin S, Chiu D, Graue R, Zerillo JA. From metrics to practice: identifying preventable emergency department visits for patients with cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. Published online November 7, 2020. doi:10.1007/s00520-020-05874-3

Impact of a Dedicated Cancer Urgent Care Center on Acute Care Utilization

2021 ◽  
pp. OP.21.00183
Author(s):  
Bonnie E. Gould Rothberg ◽  
Maureen E. Canavan ◽  
Sophia Mun ◽  
Tannaz Sedghi ◽  
Tracy Carafeno ◽  
...  
Keyword(s):  
Acute Care ◽  
Hospital Admissions ◽  
Clinical Pathways ◽  
Care Center ◽  
Hospitalization Rate ◽  
Urgent Care ◽  
Advanced Practice ◽  
Urgent Care Center ◽  
Care Clinic ◽  
Ed Visits

PURPOSE: Acute care imposes a significant burden on patients and cancer care costs. We examined whether an advanced practice provider-driven, cancer-specific urgent care center embedded within a large tertiary academic center decreased acute care use among oncology patients on active therapy. MATERIALS AND METHODS: We conducted a quasi-experimental study anchored around the Oncology Extended Care Clinic (OECC) opening date. We evaluated two parallel 4-month periods: a post-OECC period that followed a 5-month run-in phase, and the identical calendar period 1 year earlier. Our primary outcomes included all emergency department (ED) presentations and hospital admissions during the 3-month window following the index provider visit. We used Poisson models to calculate absolute pre-OECC v post-OECC rate differences. RESULTS: Our cohort included 2,095 patients in the pre-OECC period and 2,188 in the post-OECC period. We identified 32.6 ED visits/100 patients and 41.2 hospitalizations/100 patients in the pre-OECC period, versus 28.2 ED visits/100 patients and 26.1 hospitalizations/100 patients post-OECC. After adjusting for age, sex, race and ethnicity, and practice location, we observed a significant decrease of 4.6 ED visits/100 patients during the post-OECC period (95% CI, –8.92/100 to –0.28/100; P = .04) compared with the pre-OECC period. There was no significant association between the OECC opening and hospitalization rate (rate difference: –3.29 admissions/100 patients; 95% CI, –8.24/100 to 1.67/100; P = .19). CONCLUSION: Establishing a cancer-specific urgent care center was significantly associated with a modest decrease in emergency room utilization but not with hospitalization rate. Barriers included clinic capacity, patient awareness, and physician comfort with advanced practice provider autonomy. Optimizing workflow and standardizing clinical pathways can create benchmarks useful for value-based payments.

scholarly journals Predictors of Urgent Cancer Care Clinic and Emergency Department Visits for Individuals Diagnosed with Cancer

2021 ◽  
Vol 28 (3) ◽  
pp. 1773-1789
Author(s):  
Kathleen Decker ◽  
Pascal Lambert ◽  
Katie Galloway ◽  
Oliver Bucher ◽  
Marshall Pitz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mixed Models ◽  
Cancer Care ◽  
Median Number ◽  
Emergency Department Visits ◽  
Planning Service ◽  
Care Clinic ◽  
Future Studies ◽  
Acute Complications ◽  
Ed Visits

In 2013, CancerCare Manitoba (CCMB) launched an urgent cancer care clinic (UCC) to meet the needs of individuals diagnosed with cancer experiencing acute complications of cancer or its treatment. This retrospective cohort study compared the characteristics of individuals diagnosed with cancer that visited the UCC to those who visited an emergency department (ED) and determined predictors of use. Multivariable logistic mixed models were run to predict an individual’s likelihood of visiting the UCC or an ED. Scaled Brier scores were calculated to determine how greatly each predictor impacted UCC or ED use. We found that UCC visits increased up to 4 months after eligibility to visit and then decreased. ED visits were highest immediately after eligibility and then decreased. The median number of hours between triage and discharge was 2 h for UCC visits and 9 h for ED visits. Chemotherapy had the strongest association with UCC visits, whereas ED visits prior to diagnosis had the strongest association with ED visits. Variables related to socioeconomic status were less strongly associated with UCC or ED visits. Future studies would be beneficial to planning service delivery and improving clinical outcomes and patient satisfaction.

scholarly journals Retrospective Study Evaluating Effect of Voxelotor Treatment on Acute Care Utilization during the Peak of COVID-19

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4179-4179
Author(s):  
Shivani Rao ◽  
Nicole K. Yun ◽  
James L. Coggan ◽  
Peter Wu ◽  
Teresa O'Brien ◽  
...  
Keyword(s):  
Acute Care ◽  
Statistical Significance ◽  
Advisory Board ◽  
Urgent Care ◽  
Care Utilization ◽  
Novel Therapies ◽  
Care Clinic ◽  
Acute Care Utilization ◽  
Urgent Care Clinic ◽  
Acute Medical Care

Abstract Introduction In sickle cell disease (SCD), the polymerization of deoxygenated HbS fundamentally alters the structure of the erythrocyte, producing the sickle cell that is characteristic of the disease. Clinical manifestations often perceived in patients suffering from SCD include vaso-occlusion, anemia, and hemolysis. Due to these sequelae, patients frequent the emergency room (ER), urgent care clinic, and hospital. Voxelotor, an oral medication approved by the Food and Drug Administration (FDA) in 2019 for the treatment of SCD, directly targets the pathophysiology of SCD by inhibiting deoxygenated HbS polymerization. Results of the Phase III HOPE trial indicate that the drug can increase hemoglobin levels and reduce markers of hemolysis as well as the incidence of worsening anemia in patients with SCD (Vichinsky et al. N Engl J Med 2019). The COVID-19 pandemic has posed several challenges for patients with SCD in 2020. Amid the pandemic, patients continued to seek out acute medical care, including care in the ER, urgent care clinics, and hospital. The aim of this study was to determine whether utilization of acute medical care differed for patients who received voxelotor before and after therapy in 2020. We also evaluated the utilization of healthcare through telemedicine platforms to facilitate access to novel therapies such as voxelotor for patients with SCD. Methods 13 patients (≥18 years of age as of January 1, 2020) with SCD who had begun treatment with voxelotor between January 1, 2020 and December 31, 2020 were included in the initial analysis. Six patients were excluded from final analysis: three discontinued treatment due to side effects, one was noncompliant with treatment, and two were lost to follow-up. Acute care utilization, measured by the number of times each patient visited the ER, urgent care clinic, and hospital was compared for each patient in the period six months prior to their first dose of voxelotor and in the period six months after their last dose of the drug in 2020 using paired t-tests and Wilcoxon matched-pairs signed rank tests. Demographic information and the type of visit at which patients agreed to proceed with voxeletor was recorded for each patient. Simple linear regressions and multiple regressions controlled for covariates, defined as sex, BMI, age, type of insurance coverage, and duration of treatment. Results All seven (100%) patients discussed voxelotor treatment with their provider during a telehealth video visit. In the period before initiating treatment, patients frequented the ER an average of 2.71 (SD=6.75) times. In the six months after their last dose, patients visited the ER less than they had in the period prior to treatment, on average 0.57 (SD=0.79) times. This difference did not achieve statistical significance (p>0.9999). The mean number of visits to the urgent care clinic in the six months before treatment was 2.71 (SD=6.75) compared to 2 (SD=4) in the period after patients' last dose in 2020. This finding was not statistically significant (p>0.9999). Hospitalizations, on average, decreased significantly from 5.14 (SD=2.34) in the six months before starting treatment to 1.57 (SD=0.98) after ending therapy for 2020 (p=0.0015). Covariates did not have an effect on the differences in acute care utilization before treatment and after last treatment in 2020. Conclusions The findings of this study imply that treatment with voxelotor was associated with a decrease in the frequency of hospitalizations for the seven patients analyzed. This finding can potentially be attributed to the efficacy of voxelotor in improving anemia and reducing complications associated with SCD. While the difference between ER visits and urgent care visits before treatment and after the last dose in 2020 did not achieve statistical significance, likely due to small sample size, the data does suggest a reduction in both outcomes. In addition, the observation that all visits in which patient and provider discussed and initiated treatment were virtual support the use of telemedicine technology to improve access to multidisciplinary care and novel therapies for SCD patients. The impact of voxelotor treatment will continue to be assessed in SCD patients at our institution, and more data from clinical encounters will lead to a greater understanding of the efficacy of voxelotor. Figure 1 Figure 1. Disclosures Jain: GBT: Speakers Bureau; Novartis: Speakers Bureau; Sanofi: Other: advisory board; Argenx: Other: advisory board; DOVA: Other: advisory board.

Identification of patients at high risk for preventable emergency department visits and inpatient admissions after starting chemotherapy: Machine learning applied to comprehensive electronic health record data.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1511-1511
Author(s):  
Dylan J. Peterson ◽  
Nicolai P. Ostberg ◽  
Douglas W. Blayney ◽  
James D. Brooks ◽  
Tina Hernandez-Boussard
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Electronic Health Record ◽  
Acute Care ◽  
Cancer Care ◽  
Model Performance ◽  
Emergency Department Visits ◽  
Health Record ◽  
Patients At Risk ◽  
Ed Visits

1511 Background: Acute care use is one of the largest drivers of cancer care costs. OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy is a CMS quality measure that will affect reimbursement based on unplanned inpatient admissions (IP) and emergency department (ED) visits. Targeted measures can reduce preventable acute care use but identifying which patients might benefit remains challenging. Prior predictive models have made use of a limited subset of the data available in the Electronic Health Record (EHR). We hypothesized dense, structured EHR data could be used to train machine learning algorithms to predict risk of preventable ED and IP visits. Methods: Patients treated at Stanford Health Care and affiliated community care sites between 2013 and 2015 who met inclusion criteria for OP-35 were selected from our EHR. Preventable ED or IP visits were identified using OP-35 criteria. Demographic, diagnosis, procedure, medication, laboratory, vital sign, and healthcare utilization data generated prior to chemotherapy treatment were obtained. A random split of 80% of the cohort was used to train a logistic regression with least absolute shrinkage and selection operator regularization (LASSO) model to predict risk for acute care events within the first 180 days of chemotherapy. The remaining 20% were used to measure model performance by the Area Under the Receiver Operator Curve (AUROC). Results: 8,439 patients were included, of whom 35% had one or more preventable event within 180 days of starting chemotherapy. Our LASSO model classified patients at risk for preventable ED or IP visits with an AUROC of 0.783 (95% CI: 0.761-0.806). Model performance was better for identifying risk for IP visits than ED visits. LASSO selected 125 of 760 possible features to use when classifying patients. These included prior acute care visits, cancer stage, race, laboratory values, and a diagnosis of depression. Key features for the model are shown in the table. Conclusions: Machine learning models trained on a large number of routinely collected clinical variables can identify patients at risk for acute care events with promising accuracy. These models have the potential to improve cancer care outcomes, patient experience, and costs by allowing for targeted preventative interventions. Future work will include prospective and external validation in other healthcare systems.[Table: see text]

Utilizing an advanced practice provider (APP) led acute care clinic to improve access to high quality, patient centered, cost effective cancer care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14007-e14007
Author(s):  
Megan Spradlin ◽  
Kasey Bowden ◽  
Sarena Zabilla ◽  
Elizabeth R Kessler
Keyword(s):  
Acute Care ◽  
Symptom Management ◽  
Blood Platelets ◽  
Cost Effective ◽  
Patient Centered ◽  
High Quality ◽  
Care Clinic ◽  
Anti Cancer ◽  
Oncology Care ◽  
Ed Visits

e14007 Background: The medical oncology patient population is at high risk for adverse effects and complications related to anti-cancer treatments. The cost of oncology care is projected to reach almost $160 billion in 2020. The ongoing cost trajectory has placed a significant financial burden on patients, families, and society as a whole. The Centers for Medicare and Medicaid Service (CMS) has developed a new payment and delivery model that identifies potentially preventable conditions for ED visits/rehospitalizations among patients that are receiving anti-cancer therapies. Proposed CMS changes have created increased urgency around avoiding preventable ED visits/rehospitalizations. In response to the need for high quality, patient centered, cost effective care, we have established an APP-led acute care clinic that specializes in oncology care. Methods: The Clinical Assessment and Rapid Evaluation (CARE) Clinic offers acute care and symptom management catered to the oncology population. Patients are able to receive lab and imaging work up in addition to intervention with IV fluids, anti-emetics, opioids, electrolytes or antibiotics, as well as blood/platelets as warranted. To assess patient satisfaction, we created an anonymous four question survey delivered to CARE clinic patients over a two month period. Results: Seventy five surveys were collected. Pain and nausea were the leading reasons for encounters. 91% of patients rated their care as excellent, while 9% of patients rated their care as good. 33% of patients reported they would have been seen in the ED if the CARE Clinic was not available. Conclusions: The CARE Clinic represents a unique, one of the first of its kind, acute care and symptom management entity that utilizes an APP model to provide high quality care at a low cost. More research is needed to identify if this model can create statistically significant reduction in ED visits and rehospitalizations, however current data suggests that patients are highly satisfied with this unique method of care delivery. Sources Handley NR, Schuchter LM, Bekelman JE. Best Practices for Reducing Unplanned Acute Care for Patients With Cancer. Journal of Oncology Practice. 2018;14(5):306-313. doi:10.1200/jop.17.00081.

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.

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 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.

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