Super-Utilization of Health Care Resources Among Gynecologic Oncology Patients. (September 2018)

• Record Type: Journal Article
• Authors: Hay, Casey M.; Kelley, Joseph L.; Edwards, Robert P.; Pombier, Kathleen M.; Comerci, John T.
• Is Part Of: American journal of medical quality. Volume 33:Number 5(2018)
• Page Start: 509
• Page End: 513
• Publication Date: 2018-09
• Subjects: super-utilization -- resource utilization -- palliative care -- symptom management -- oncology; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860618757343
• Languages: English
• ISSNs: 1062-8606

Abstract

Super-utilizers account for many emergency department visits (EDV) and hospitalizations. Among Medicare/Medicaid patients, 5% to 10% account for >50% of spending. Little is known about super-utilization in gynecologic oncology. Charts of 64 gynecologic oncology patients with ≥3 EDV and/or admissions over 12 months were reviewed retrospectively. Cancer type distribution was 47% ovarian, 23% cervical, 23% endometrial, and 6% vulvar. Treatment at index visit was 61% chemotherapy, 16% no treatment, 8% recent surgery, and 6% radiation. Mean visits was 5.7 (SD 3.9, range 3-28). Most common presenting complaints were gastrointestinal and pain. Patients near end of life were more likely to be admitted. EDV frequently occurred outside standard work hours (63%). EDV/admissions resulted in total variable expenses of $1 462 581 ($982 933 direct expense, $479 648 service expense). Interventions to decrease super-utilization could target symptom management, off-hour support, patients on chemotherapy, and end of life. Approaches could include multidisciplinary resources, palliative care teams, extending office hours, and earlier initiation of hospice.