Unplanned acute care utilization—emergency department and hospitalizations—for cancer patients is a major problem, according to a new study.
For the study, University of Pennsylvania researcher Nathan Handley, MD, MBA, and colleagues, conducted a literature review, looking at PubMed articles published between 2000 and 2017. They also evaluated five care models that have defined and developed systems to deliver high quality oncology care. These models included: the National Committee for Quality Assurance patient-centered medical home; the Community Oncology Medical Home; the CMS Oncology Care Model; and the Commission on Cancer Oncology Medical Home. They also interviewed thought leaders from across the country.
They found that evidence-based strategies for reducing unplanned acute care for patients with cancer fall into five main categories:
- Identifying patients at high risk for unplanned acute care, which includes interventions like risk-stratification models and predictive analytics.
- Enhancing access and care coordination, which includes interventions like standardized care transitions and patient navigator programs.
- Standardized clinical pathways for symptom management, which includes interventions like outpatient phone triage pathways and incorporation of supportive care into disease management pathways.
- Developing urgent cancer care tactics, which includes interventions like flexible scheduling to create urgent care slots in an outpatient clinic and dedicated acute cancer treatment clinics.
- Using early palliative care, which includes integrating palliative care clinics into outpatient clinics and creating triggers for palliative care consultation.
“Within each of the five strategies, a range of possible interventions exist, so health systems can tailor their interventions based on their needs and existing infrastructure,” says Handley, fellow, Division of Hematology/Oncology, University of Pennsylvania. “Some health systems, for example, may have the volume to be able to justify creating a dedicated urgent care center (or even an emergency department) for patients with cancer; others may find that creating urgent care slots in existing clinics is sufficient.”
According to Handley, he and his colleagues described the impact each of these strategies can have on ED visits, hospitalizations, and rehospitalizations based on reports from the literature. “One nurse navigation program reduced ED visits by 20% and hospitalizations by 7%. One practice’s phone triage system—which incorporated customized symptoms management algorithms—led to a 60% reduction in ED visits and a 50% reduction in all-cause hospitalizations. The point here is that the strategies have evidence to back them up,” he says.
Patients with cancer have some of the highest readmission rates of any patient group—a number of studies suggest the 30-day readmission rate is somewhere around 25%, according to Handley. “While these have often been thought of as unpreventable, more and more studies are suggesting that’s not always the case. Somewhere between 20% and 50% of hospitalizations in these patients are probably preventable.”
CMS has proposed adding a measure, OP-35, to the Hospital Outpatient Quality Reporting Program, according to Handley. “This would provide a definition for ‘preventable’ ED visits and hospitalizations within 30 days of a patient getting chemotherapy—and includes things like anemia, nausea, dehydration, neutropenia, fever, etc. This measure will tentatively go into effect in 2020.”