Examining patient specific factors associated with inpatient hospital length of stay for solid tumor oncology patients from low socioeconomic communities in Milwaukee, WI.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 232-232
Author(s):  
Sailaja Kamaraju ◽  
Bethany Canales ◽  
Tamiah Wright ◽  
John A. Charlson ◽  
Aniko Szabo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cancer Diagnosis ◽  
Solid Tumor ◽  
Hospital Length Of Stay ◽  
Patient Specific ◽  
Low Ses ◽  
Oncology Patients ◽  
Low Socioeconomic ◽  
Specific Factors ◽  
Primary Payer

232 Background: In a retrospective analysis at the Medical College of Wisconsin’s Cancer Center, we identified longer inpatient length of stay (LOS) for patients residing in low-socioeconomic (SES) ZIP Codes in Milwaukee County compared to their high-SES counterparts in 2020 (7.3 days compared to 7.1 days). Under the auspices of American Society of Clinical Oncology’ Quality Training Program (QTP) initiative, this study examined specific factors related to prolonged LOS for solid tumor oncology patients. Methods: This analysis includes initial CY20 LOS medical record data for select patient service areas. Supplemental data includes disease registry data, diagnostic data, and SES data determined by patient ZIP Code. We identified patients 18 years and older with a diagnosis of common oncologic malignancies from 1/1/2020-12/31/2020 (breast, gastrointestinal (GI), genitourinary (GU), gynecologic (GYN), head and neck (H&N), and lung cancers). Poisson regression models with robust standard errors were used to compare the LOS index (LOSi) between groups of patients based on race, SES group, primary payer, and BMI. Results: A total of 1,637 patients with solid tumor diagnosis admitted to hematology and oncology units were identified. The LOSi did not vary significantly by race (range 0.95 – 1.07, p = 0.40) or primary payer (range 0.99 – 1.04, p = 0.59), but lower SES groups tended to have longer LOSi, with LOSi ratio above 1 compared to high SES (low SES: 1.16, p = 0.2; medium-low SES: 1.24, p = 0.06). Among patients with breast cancer diagnosis, Black (LOSi = 1.24, p = 0.01), medium-low SES (LOSi = 1.46, p = 0.02), Medicaid (LOSi = 1.40, p = 0.00), underweight (LOSi = 1.66, p = 0.00), and overweight (LOSi = 1.23, p = 0.01) patients had slightly longer LOSi, with LOSi ratio above 1. Among patients with H&N cancer diagnosis, Black patients (LOSi = 0.77, p = 0.02) had slightly shorter LOSi, with LOSi ratio below 1. The LOSi did not vary significantly by other factors for patients with H&N cancer diagnosis or the other common oncologic malignancies evaluated. Conclusions: This study shows how patient-specific factors such as race, SES, primary payer, and BMI contribute to inpatient LOS. Healthcare systems may benefit by addressing patient-specific barriers and factors such as body mass index, SES and SDH, to reduce hospital LOS.

Leveraging social determinants of health to reduce hospital length of stay: A pilot quality improvement project to address inpatient cancer patients' barriers during the COVID 19 pandemic.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 233-233
Author(s):  
Sailaja Kamaraju ◽  
Dave Atkinson ◽  
Thomas Wetzel ◽  
Tamiah Wright ◽  
John A. Charlson ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Length Of Stay ◽  
Social Determinants Of Health ◽  
Cancer Patients ◽  
Social Determinants ◽  
Solid Tumor ◽  
Determinants Of Health ◽  
Patient Specific ◽  
Discharge Process ◽  
Oncology Patients

233 Background: Prior reports from our institution demonstrated high rates of racial segregation, unfavorable social determinants of health (SDoH) in Milwaukee, WI, and statewide reports of inferior outcomes for cancer patients from minority communities. At the Medical College of Wisconsin's Cancer Center (Milwaukee, WI), during the first through last quarters of 2018-2019, cancer patients from the low socioeconomic status (SES) communities who were hospitalized to inpatient oncology units had an average length of stay (LOS) of 7.2 days compared to 5.6 days for high SES group. Under the auspices of the American Society of Clinical Oncology's Quality Training Program (QTP) initiative, we aimed to reduce the hospital LOS by 10% or less by May 2021 for inpatient oncology teams. Methods: A multidisciplinary team collaboration between the inpatient and outpatient providers was developed during this QI initiative. We examined LOS index data, payer types, and other diagnostic criteria for the oncology inpatient solid tumor service and two comparator services (bone marrow transplant, BMT; internal medicine). We generated workflow, a cause-and-effect diagram, and a Pareto diagram to determine the relevant factors associated with longer hospital LOS. Institution-wide implementation of the SDH screen project was launched to evaluate and address specific barriers to SDoH to expedite a safe discharge process during the pandemic. Results: Through one test of change (Plan-Do-Study-Act cycles 1, 2 &3), we identified the problem of extended LOS and patient-related barriers to discharge during this QI initiative. Compared to the baseline LOS, after the launch of the SDoH screen project, there was a 6.5% decrease in the inpatient average LOS for oncology patients (7.89 to 7.40days, p = 0.004),10.7% for BMT (15.96 days to14.26, p = 0.166), and 2.4% for Internal Medicine (4.61 to 4.50 to days, p = 0.131). There was a 10.0% decrease in LOS (8.07 to 7.26 days, p = < 0.001) for the three specialties combined. With collaboration from inpatient and outpatient providers, appropriate referrals were generated to address patient-specific SDH before discharge (i.e., transportation coordination, nutritional and physical therapy referrals, social worker assistance with food, and housing insecurities). Conclusions: In this pilot project, implementing SDoH screening-based-care delivery at the time of inpatient admission demonstrated a slight improvement in LOS for solid tumor oncology patients and provided timely referrals, opportunities to engage and explore the discharge facilities early on during the COVID 19 pandemic. With this preliminary data, we plan to continue to expand our efforts through a systemwide implementation of this SDoH survey both in the inpatient and outpatient settings to address cancer inequities.

A retrospective analysis of the effect of patient-specific factors on voriconazole concentrations in oncology patients

2011 ◽  
Vol 18 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Lindsey R Lombardi ◽  
Todd A Miano ◽  
Jennifer L Davis ◽  
Steven C Morgan ◽  
Steven C Goldstein ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Patient Specific ◽  
Oncology Patients ◽  
Specific Factors

scholarly journals Perioperative Individualized Goal Directed Therapy for Cardiac Surgery: A Historical-Prospective, Comparative Effectiveness Study

2021 ◽  
Vol 10 (3) ◽  
pp. 400
Author(s):  
Davinder Ramsingh ◽  
Huayong Hu ◽  
Manshu Yan ◽  
Ryan Lauer ◽  
David Rabkin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patient Specific ◽  
Goal Directed Therapy ◽  
Prolonged Length ◽  
Icu Length Of Stay ◽  
Increased Risk ◽  
Comparative Effectiveness Study

Introduction: Cardiac surgery patients are at increased risk for post-operative complications and prolonged length of stay. Perioperative goal directed therapy (GDT) has demonstrated utility for non-cardiac surgery, however, GDT is not common for cardiac surgery. We initiated a quality improvement (QI) project focusing on the implementation of a GDT protocol, which was applied from the immediate post-bypass period into the intensive care unit (ICU). Our hypothesis was that this novel GDT protocol would decrease ICU length of stay and possibly improve postoperative outcomes. Methods: This was a historical prospective, QI study for patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Integral to the QI project was education towards all associated providers on the concepts related to GDT. The protocol involved identifying patient specific targets for cardiac index and mean arterial pressure. These targets were maintained from the post-CPB period to the first 12 h in the ICU. Statistical comparisons were performed between the year after GDT therapy was launched to the last two years prior to protocol implementation. The primary outcome was ICU length of stay. Results: There was a significant decrease in ICU length of stay when comparing the year after the protocol initiation to years prior, from a median of 6.19 days to 4 days (2017 vs. 2019, p < 0.0001), and a median of 5.88 days to 4 days (2018 vs. 2019, p < 0.0001). Secondary outcomes demonstrated a significant reduction in total administered volumes of inotropic medication(milrinone). All other vasopressors demonstrated no differences across years. Hospital length of stay comparisons did not demonstrate a significant reduction. Conclusion: These results suggest that an individualized goal directed therapy for cardiac surgery patients can reduce ICU length of stay and decrease amount of inotropic therapy.

Intervention to Discontinue Parenteral Antimicrobial Therapy in Patients Hospitalized with Pulmonary Infections: Effect on Shortening Patient Stay

1992 ◽  
Vol 13 (1) ◽  
pp. 21-32 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Debra E. Nerenberg ◽  
James M. Shultz ◽  
Kenneth C. Slater
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Cost Savings ◽  
Severity Of Illness ◽  
Cost Effective ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patient Specific ◽  
Practice Characteristics ◽  
Alternative Drug

AbstractObjectives:Current efforts to contain antimicrobial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stayMethods:A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians withnonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and30-day postdischarge courses of patients of physicianswhohad been contacted by the nurse (cases) and those who had not (controls).Results:Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was$884/patient). In 11 (21%) episodes, case physicians continuedparenteraltherapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was$704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups.Conclusions:The major cost-saving potential for shifting from par-enter-al to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.

scholarly journals PD53-07 ANALYZING PATIENT-SPECIFIC FACTORS CONTRIBUTING TO EXTENDED PACU LENGTH OF STAY AND SUBSEQUENT COST: A QUALITY IMPROVEMENT INITIATIVE

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Patrick Hensley* ◽  
Jeffrey Goodwin ◽  
Adam Dugan ◽  
Mauro Hanaoka ◽  
Jason Bylund ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Patient Specific ◽  
Quality Improvement Initiative ◽  
Specific Factors
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