Comparing characteristics and outcomes of cancer to non-cancer patients admitted to general internal medicine (GIM).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 21-21
Author(s):  
Lawson Eng ◽  
Amol A Verma ◽  
Saeha Shin ◽  
Afsaneh Raissi ◽  
Alejandro Berlin ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Administrative Data ◽  
Interventional Procedures ◽  
Care Delivery ◽  
Admission Rate ◽  
Patient Discharge ◽  
Tract Infections ◽  
To Receive

21 Background: Cancer prevalence is rising and there is a corresponding increase in hospitalizations across the cancer continuum. However, little is known about the patterns of care and outcomes of cancer inpatients as administrative data may not capture in-hospital details including investigations and medications required for characterization. Understanding how cancer inpatients are managed and their outcomes can help to optimize care delivery. Methods: We conducted a multicenter study of all patients admitted to GIM at seven hospitals (Toronto, Canada) from 2010 to 2017 where we deterministically linked administrative data with each hospital’s electronic information (pharmacy, orders, notes, laboratory/imaging and results) at the patient level. Multivariable regression models compared characteristics and outcomes between cancer and non-cancer patients for the top 5 non-cancer patient discharge diagnoses. Results: Among 230,040 hospitalizations, 15% had cancer listed as an ICD-10 comorbidity. The most common cancer disease sites were gastrointestinal (20%), lung (13%) and leukemia (11%). The most common discharge diagnoses for cancer patients were disease progression (9%), palliative care (6%), pneumonia (4%), leukemia (4%) and lung cancer (4%), while for non-cancer patients were: heart failure (5%), pneumonia (5%), stroke (5%), COPD (5%) and urinary tract infections (5%). In general, compared to non-cancer patients, cancer patients were younger (70 vs 72), had greater length of stay (LOS; 6.4 vs 4.6 days), in-hospital mortality (16% vs 5%), ICU use (12% vs 11%), 30 day re-admission rate (17% vs 10%) and were more likely to receive CTs (64% vs 52%), MRIs (14% vs 12%) and interventional procedures (22% vs 8%) (p < 0.001, all comparisons). When evaluating the top 5 non-cancer patient discharge diagnoses, results (adjusted for age, gender, Charlson comorbidity score and hospital) were similar wherein cancer patients had a higher in-hospital mortality (aOR = 2.02 p < 0.001), 30 day re-admission rate (aOR = 1.09 p = 0.08) and were more likely to receive CTs (aOR = 1.88 p < 0.001), MRIs (aOR = 1.66 p < 0.001) or interventional procedures (aOR = 1.78 p < 0.001), despite similar mean LOS (5.7 vs 5.1 days p = 0.35). Results were similar across discharge diagnoses. Conclusions: Cancer patients represent a unique population on GIM and have higher resource use, mortality and LOS compared to non-cancer patients, with similar trends even for the same non-cancer diagnoses. Specialized models of care for hospitalized cancer patients may be warranted.

scholarly journals Processes of care and outcomes for homeless patients hospitalised for cardiovascular conditions at safety-net versus non-safety-net hospitals: cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046959
Author(s):  
Atsushi Miyawaki ◽  
Dhruv Khullar ◽  
Yusuke Tsugawa
Keyword(s):  
Hospital Mortality ◽  
Health Outcomes ◽  
Care Delivery ◽  
Bypass Graft ◽  
Safety Net ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Homeless Adults ◽  
To Receive

ObjectivesEvidence suggests that homeless patients experience worse quality of care and poorer health outcomes across a range of medical conditions. It remains unclear, however, whether differences in care delivery at safety-net versus non-safety-net hospitals explain these disparities. We aimed to investigate whether homeless versus non-homeless adults hospitalised for cardiovascular conditions (acute myocardial infarction (AMI) and stroke) experience differences in care delivery and health outcomes at safety-net versus non-safety-net hospitals.DesignCross-sectional study.SettingData including all hospital admissions in four states (Florida, Massachusetts, Maryland, and New York) in 2014.ParticipantsWe analysed 167 105 adults aged 18 years or older hospitalised for cardiovascular conditions (age mean=64.5 years; 75 361 (45.1%) women; 2123 (1.3%) homeless hospitalisations) discharged from 348 hospitals.Outcome measuresRisk-adjusted diagnostic and therapeutic procedure and in-hospital mortality, after adjusting for patient characteristics and state and quarter fixed effects.ResultsAt safety-net hospitals, homeless adults hospitalised for AMI were less likely to receive coronary angiogram (adjusted OR (aOR), 0.42; 95% CI, 0.36 to 0.50; p<0.001), percutaneous coronary intervention (aOR, 0.52; 95% CI, 0.44 to 0.62; p<0.001) and coronary artery bypass graft (aOR, 0.43; 95% CI, 0.26 to 0.71; p<0.01) compared with non-homeless adults. Homeless patients treated for strokes at safety-net hospitals were less likely to receive cerebral arteriography (aOR, 0.23; 95% CI, 0.16 to 0.34; p<0.001), but were as likely to receive thrombolysis therapy. At non-safety-net hospitals, we found no evidence that the probability of receiving these procedures differed between homeless and non-homeless adults hospitalised for AMI or stroke. Finally, there were no differences in in-hospital mortality rates for homeless versus non-homeless patients at either safety-net or non-safety-net hospitals.ConclusionDisparities in receipt of diagnostic and therapeutic procedures for homeless patients with cardiovascular conditions were observed only at safety-net hospitals. However, we found no evidence that these differences influenced in-hospital mortality markedly.

scholarly journals Prediction of in-hospital mortality after pancreatic resection in pancreatic cancer patients: A boosting approach via a population-based study using health administrative data

PLoS ONE ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. e0178757 ◽  
Author(s):  
Jose F. Velez-Serrano ◽  
Daniel Velez-Serrano ◽  
Valentin Hernandez-Barrera ◽  
Rodrigo Jimenez-Garcia ◽  
Ana Lopez de Andres ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Administrative Data ◽  
Pancreatic Resection ◽  
Population Based ◽  
Population Based Study ◽  
Health Administrative Data

Economic impact of hyponatremia in hospitalized patients with cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17053-17053
Author(s):  
M. A. Callahan ◽  
H. T. Do ◽  
D. W. Caplan ◽  
K. Yoon-Flannery ◽  
R. Seifeldin
Keyword(s):  
Hospital Mortality ◽  
Cancer Patients ◽  
Admission Rate ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Severe Hyponatremia ◽  
Accounting Data ◽  
Risk Of Death ◽  
Control Subjects

17053 Background: Hyponatremia, defined as a serum sodium concentration ([Na+]) =134 mEq/L, is a common electrolyte abnormality in hospitalized cancer patients that may be caused by the primary tumor or metastasis, diagnostic or therapeutic interventions, or a secondary complication. Hospital-acquired hyponatremia is associated with higher costs of care, but many patients present with hyponatremia at admission. Methods: This retrospective case-controlled study assessed the outcomes and cost of care among patients hospitalized for neoplasm who presented with hyponatremia at admission. Laboratory and cost-accounting data from 841 adult patients admitted to an 811-bed university hospital between January 2004 and May 2005 with a principal diagnosis of neoplasm and either mild-to- moderate or moderate-to-severe hyponatremia (serum [Na+] 130–134 mEq/L or <130 mEq/L, respectively) were compared with data from control subjects with matching ICD-9 codes and normal serum [Na+] (135–145 mEq/L) at admission during the same period. Endpoints included hospital length of stay (LOS), ICU admissions, in-hospital mortality, and total costs per admission. Results: Hyponatremia was evident in 18.9% of patients admitted for neoplasm. Patients with moderate-to-severe hyponatremia (n=192) and mild-to- moderate hyponatremia (n=649) demonstrated a significantly longer hospital LOS, higher ICU admission rate, higher in-hospital mortality, and higher median costs than control subjects (n=3610) (Table). These differences among groups remained significant after adjustments were made for age, race, sex, and comorbidity score. Conclusions: Cancer patients presenting with hyponatremia at admission have a longer hospital LOS and higher risk of death and cost of care than do cancer patients presenting without hyponatremia. [Table: see text] No significant financial relationships to disclose.

PSYCHOLOGICAL REHABILITATION AND SCREENING OF EMOTIONAL STRESS IN CANCER PATIENTS

2017 ◽  
Vol 63 (2) ◽  
pp. 316-319 ◽  
Author(s):  
Valentina Chulkova ◽  
Tatyana Semiglazova ◽  
Margarita Vagaytseva ◽  
Andrey Karitskiy ◽  
Yevgeniy Demin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Emotional Stress ◽  
Self Esteem ◽  
Breast Cancer Patients ◽  
Psychological Study ◽  
Psychological Assistance

Psychological rehabilitation is an integral part of rehabilitation of a cancer patient. Psychological rehabilitation is aimed at a patient adaptation in the situation of the disease and improvement his quality of life. Understanding of an oncological disease is extreme and (or) crisis situation and monitoring dynamics of the psychological statement of a patient allows using differentiated approach in the provision of professional psychological assistance. The modified scale of self-esteem level of distress (IPOS) was used for screening of mental and emotional stress of cancer patients. There were selected groups of cancer patients who were most in need of professional psychological assistance. Results of a psychological study of one of these groups - breast cancer patients - are presented.

Preferences to Receive Unsolicited Findings of Germline Genome Sequencing in a Large Population of Cancer Patients

2018 ◽  
Author(s):  
R.M. Bijlsma ◽  
R.H.P. Wouters ◽  
H. Wessels ◽  
S. Sleijfer ◽  
L.V. Beerepoot ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Genome Sequencing ◽  
Large Population ◽  
To Receive

High-Volume Hospitals with High-Volume and Low-Volume Surgeons: Is There a “Field Effect” for Pancreaticoduodenectomy?

2016 ◽  
Vol 82 (5) ◽  
pp. 407-411 ◽  
Author(s):  
Thomas W. Wood ◽  
Sharona B. Ross ◽  
Ty A. Bowman ◽  
Amanda Smart ◽  
Carrie E. Ryan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Field Effect ◽  
Hospital Volume ◽  
Patient Discharge ◽  
High Volume ◽  
Surgeon Volume ◽  
Hospital Charges ◽  
Leapfrog Group ◽  
Discharge Status ◽  
Low Volume

Since the Leapfrog Group established hospital volume criteria for pancreaticoduodenectomy (PD), the importance of surgeon volume versus hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine whether low-volume surgeons attain the same outcomes after PD as high-volume surgeons at high-volume hospitals. PDs undertaken from 2010 to 2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified. Surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges were examined relative to surgeon volume. Six high-volume hospitals were identified. Each hospital had at least one surgeon undertaking ≥ 12 PDs per year and at least one surgeon undertaking < 12 PDs per year. Within these six hospitals, there were 10 “high-volume” surgeons undertaking 714 PDs over the three-year period (average of 24 PDs per surgeon per year), and 33 “low-volume” surgeons undertaking 225 PDs over the three-year period (average of two PDs per surgeon per year). For all surgeons, the frequency with which surgeons undertook PD did not predict LOS, in-hospital mortality, discharge status, or hospital charges. At the six high-volume hospitals examined from 2010 to 2012, low-volume surgeons undertaking PD did not have different patient outcomes from their high-volume counterparts with respect to patient LOS, in-hospital mortality, patient discharge status, or hospital charges. Although the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there seems to be a hospital “field effect.”

Trends in hospitalization and in-hospital mortality of patients with heart failure in Spain. A population-based study (2003–2015)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.L Bonilla Palomas ◽  
M.P Anguita-Sanchez ◽  
F.J Elola ◽  
J.L Bernal ◽  
C Fernandez-Perez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
National Health System ◽  
Admission Rate ◽  
Population Data ◽  
Principal Diagnosis ◽  
Data Set ◽  
Discharge Rates ◽  
Mortality Ratio

Abstract Background Heart failure (HF) is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. Purpose To investigate trends in HF hospitalization and in-hospital mortality rates. Methods We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2003–2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We analyzed trends in hospital discharge rates for HF (discharge rates were weighted by age and gender) an in-hospital mortality. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality (which individually considers the performance of the hospital where the patient is attended) and expected mortality (which considers a standard performance according to the average of all hospitals) multiplied by the crude rate of mortality. RSMR was calculated using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Temporal trend during the observed period was modelled using Poisson regression analysis with year as the only independent variable. In this model, the incidence rate ratio (IRR) and their 95% confidence intervals (95% CI) was calculated. Results A total of 1 254 830 episodes of HF were selected. Throughout 2003–2015 the number of hospital discharges with principal diagnosis of HF increased by 61% (IRR: 1.04; CI: 1.03–1.04; p&lt;0.001), meanwhile the crude mortality rate and the mean length of stay (LOS) diminished significantly (IRR: 0.99; CI: 0.98–1; and IRR: 1.04; CI: 0.99–0.99; p&lt;0.001, for both). Discharge rates weighted by age and sex showed a statistically significant increase during the period (IRR: 1.03; CI: 1.03–1.03; p&lt;0.001); however, whereas discharge rates increased significantly in older groups of age (≥75 years old) (IRR: 1–1.02; p&lt;0.001) they diminished in younger groups of age (45–74 years old) (IRR: 0.99; p&lt;0.001 and there was not a significant trend in the discharge rates for the group of 35–44 years old (Figure). The risk-standardized in-hospital mortality ratio did not significantly change throughout 2003–2015 (IRR: 0.997; CI: 0.992–1; p=0.32), however the risk-standardized LOS ratio diminished from 1.07 in 2003 to 0.97 in 2015 (IRR: 0.98: IC: 0.98–0.99; p&lt;0.001). Conclusions From 2003 to 2015, HF admission rate increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population over 75. The crude in-hospital mortality rate diminished significantly for the same period, but the risk-standardized in-hospital mortality ratio did not significantly change. Figure 1 Funding Acknowledgement Type of funding source: None

Attention to diet, exercise, and weight in the oncology clinic: Results of a national patient survey.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10549-10549
Author(s):  
Jennifer A. Ligibel ◽  
Lori J. Pierce ◽  
Catherine M. Bender ◽  
Tracy E Crane ◽  
Christina Marie Dieli-Conwright ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Online Survey ◽  
Early Stage ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
Related Factors ◽  
Increased Risk ◽  
Diet And Exercise ◽  
To Receive

10549 Background: Obesity and related factors are increasingly associated with increased risk of developing and dying from cancer. The American Society of Clinical Oncology (ASCO) conducted a survey of cancer patients to assess their experience in receiving recommendations and referrals related to weight, diet and exercise as a part of their cancer care. Methods: An online survey was distributed to potential participants between March and June 2020 via ASCO channels and patient advocacy organizations, with an estimated reach of over 25,000 individuals. Eligibility criteria included being 18 years, living in the US, and having been diagnosed with cancer. Logistic regression was used to determine factors associated with recommendation and referral patterns. Results: In total, 2419 individuals responded to the survey. Most respondents were female (75.5%), 61.8% had an early-stage malignancy, 38.2% had advanced disease, and 49.0% were currently receiving treatment. Breast cancer was the most common cancer type (36.0%). Average BMI was 25.8 kg/m2. The majority of respondents consumed £2 servings of fruits and vegetables per day (50.9%) and exercised £2 times per week (50.4%). Exercise was addressed at most or some oncology visits in 57.5% of respondents, diet in 50.7%, and weight in 28.4%. Referrals were less common: 14.9% of respondents were referred to an exercise program, 25.6% to a dietitian and 4.5% to a weight management program. In multiple regression analyses, racial and ethnicity minority respondents were more likely to receive advice about diet (Odds Ratio [OR] 1.92, 95% CI 1.56-2.38) and weight (OR 1.64, 95% CI 1.23-2.17) compared to non-Hispanic whites, individuals diagnosed with cancer in the past 5 yrs (vs > 5 yrs) were more likely to receive advice about exercise (OR 1.48, 95% CI 1.23-1.79), and breast cancer patients were more likely to receive advice about exercise (OR 1.37, 95% CI 1.11-1.68) and weight (OR 1.46, 95% CI 1.03-2.07) than other cancer patients. Overall, 74% of survey respondents had changed their diet or exercise after cancer diagnosis. Respondents reporting that their oncologist spoke to them about increasing exercise or eating healthier foods were more likely to report a change in behavior than those whose oncologists did not (exercise: 79.6% vs 69.0%, P < 0.001; diet 81.1% vs 71.4%, P < 0.001). Respondents whose oncologist had spoken to them about exercise were more likely to exercise > 2 times per week compared to respondents whose oncologists did not address exercise (53.5% vs 44.1%, P < 0.001). Conclusions: In a national survey of oncology patients, slightly more than half of respondents reported attention to diet and exercise during oncology visits. Provider recommendations for diet and exercise were associated with positive changes in these behaviors. Additional attention to diet and exercise as part of oncology visits is needed to help support healthy lifestyle change in cancer patients.

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