|The following article features coverage from the American Society of Clinical Oncology 2020 virtual meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
A retrospective study of patients with cancer showed that the majority of those presenting for a visit to an emergency department (ED) did not have a related outpatient clinical encounter in the day preceding the ED visit, according to findings presented at the ASCO20 Virtual Scientific Program.
The Centers for Medicare and Medicaid (CMS) Oncology Care Management (OCM) is a multipayer model in which participating physician practices have financial and performance accountability to improve the coordination and delivery of appropriate care to their patients undergoing chemotherapy. Through the establishment of outpatient urgent care clinics and/or the availability of telephone/secure messaging encounters, patients receiving care within OCM are given round-the-clock access to a clinician who is able to view their electronic health records (EHRs) in “real-time.”
The aim of this study was to determine whether there was a difference in the frequency and severity of regional ED visits within 6 months following cancer diagnosis for adult oncology patients who did or did not use these types of outpatient services in the 24 hours prior to the ED visit (pre-ED clinical contact with access to EHR).
For the years 2012 to 2018, data from the EHRs of 8289 patients from the Parkland Health and Hospital System (PHHS) in Dallas, Texas, and 10,817 patients included in the University of Texas Southwestern (UTSW) Gold-certified cancer registry were linked with information on ED visits and hospital encounters through a regional health information exchange. Of the patients included in the PHHS database, 78% received Medicaid/charity assistance whereas only 12% of UTSW patients were enrolled in Medicaid. The number of ED visits for these 2 respective groups of patients was 21,009 and 22,696.
A key finding of this study was that 70% of ED visits from PHHS and 66.7% of ED visits from UTSW — approximately two-thirds of all ED visits — were not preceded by a pre-ED clinical contact.
Of the pre-ED clinical contacts, telephone encounters and visits to outpatient clinics for any specialty were most common, with 8.7% and 28.2% of ED visits by PHHS and UTSW patients, respectively, preceded by telephone encounters and 16.1% and 12.4%, respectively, preceded by an outpatient clinic visit.
However, nearly all of the pre-ED clinical encounters among the UTSW patients were related to oncology, whereas only approximately 30% of the pre-ED visits among the PHHS patients were oncology-related.
Notably, the percentage of patients presenting to the ED with at least one severe condition was found to be slightly, but statistically significantly, lower for those patients who had undergone a pre-ED clinical visit (43%) compared with those who did not (46%; P <.01).
In their concluding comments, the study authors noted that “future work should identify patient-oriented options to optimize the use of clinical care and the ED.”
This research was funded by the US National Institutes of Health.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Hong A, Fullington H, Sadeghi N, et al. Are ED visits in cancer patients preventable? Care patterns before an ED visit. Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 2023.