As many as 53% of cancer patients’ emergency department (ED) visits that do not require admission could be avoided with better symptom management and greater availability of outpatient care tailored to their needs, according to a new study from the Fred Hutchinson Cancer Research Center in Seattle, Washington.
Although several studies have addressed the prevalence of ED visits among cancer patients, this is the first to systematically identify potentially preventable ED visits during treatment. Dr. Laura Panattoni and her colleagues followed cancer patients with solid tumors whose treatments included chemotherapy, radiation, or both in 13 western Washington counties.
The study began with data from 5,853 commercially insured adults (18 years of age or older) who had been diagnosed with a solid tumor and treated with chemotherapy, radiation, or both. Of that population, 1,581 patients (27%) visited the ED without being admitted during the year after starting treatment.
Panattoni and her colleagues tallied 2,400 ED visits by these 1,581 cancer patients and analyzed whether they could have been prevented.
Using a list of symptoms that federal health authorities identified as preventable, combined with symptoms targeted by patient-reported outcome tools, the researchers found that slightly more than half of these ED visits (53%) were related to symptoms that could have been managed with timely care in an outpatient setting.
The share of potentially preventable visits rose to 70% when Panattoni and her colleagues expanded the standard to include other common patient complaints as well as symptoms associated with chronic health conditions.
“At a time when federal authorities and private payers are linking insurance payments to hospital quality measures, this study points to the importance of developing methods to accurately identify those ED visits that are preventable versus those that are appropriate,” Panattoni commented.
The study found that pain was the most common reason cancer patients visited an ED. In fact, visits due to pain accounted for 27% of overall visits, with a median cost per visit of $1,127. Fever and difficulty breathing were the next two most-common reasons that brought patients to the ED, each at 6%.
Overall, the study indicated a higher median cost per visit for cancer patients compared with the cost of visits as a result of other chronic health conditions. The median cost per visit of preventable cancer-related symptoms was $1,047 compared with a median cost per visit of $335 for symptoms related to a chronic health condition.
“This represents a rare opportunity to reduce costs and improve patient outcomes,” Panattoni said, noting that investment in sharing best practices and new models of care will likely be necessary to make a significant difference.
One limitation of the study is that it did not include data from patients who were insured through Medicare. The researchers expect to receive that information in the coming months and to incorporate it into their findings.
Source: Fred Hutchinson Cancer Research Center; May 30, 2017.