The emergency department (ED) is one of the last places anyone wants to be, let alone someone with cancer. Yet more than half of ED visits by cancer patients could have been avoided had they received better symptom management tools and access to personalized outpatient care, according to a study presented (abstract 6505) at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2–6 in Chicago.1
Researchers from Fred Hutchinson Cancer Research Center in Seattle sought to learn more about the relationship between potentially preventable ED visits due to cancer compared with other chronic disease.
Led by Laura Panattoni, PhD, a staff scientist at the Hutchinson Institute for Cancer Outcomes Research (HICOR), the researchers evaluated data from 5,853 commercially insured adults diagnosed with solid tumors who were receiving treatment with chemotherapy, radiation, or both. The researchers looked at how many times the patients visited an ED. Twenty-seven percent of this group (1,581 patients) visited an ED without being admitted in the year after starting treatment.
The reason for the ED visits were found by using diagnostic codes from the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality’s Prevention Quality Indicators for Chronic Conditions. The researchers found that the most commonly listed code was for pain, with 1,054 visits. Other complaints included fever and dyspnea.
In total, 53% of visits by the patients with cancer were related to symptoms that could otherwise have been managed outside of the ED setting, and this number rose to 70% when the researchers included other common complaints associated with chronic health conditions, such as diabetes and chronic obstructive pulmonary disease.
Not only are EDs not an appropriate setting for patients with cancer, these visits were also costly. Emergency department visits related to pain—27% of all visits—had a median cost per visit of $1,127.
“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 said in a release. “This represents a rare opportunity to reduce costs and improve patient outcomes.”2 She also noted that this cost can have a significant impact on the patients and their families, adding to their financial burden through out-of-pocket costs.
Panattoni and her colleagues recommend that there be more research into the role of chronic illness and how to prevent ED visits related to issues that could be managed outside the ED setting.
- Panattoni LE, Fedorenko CR, Kreizenbeck KL, et al. The role of chronic disease in the costs of potentially preventable emergency department use during treatment: A regional study. J Clin Oncol 35, 2017 (suppl; abstr 6505).
- Hudson C. Many cancer patients’ Emergency Department visits appear preventable, Fred Hutch study finds. Fred Hutchinson Cancer Research Center. 2017 May 30.