Risk Factors for Return to the Emergency Department and Readmission in Patients With Hospital-Diagnosed Advanced Lung Cancer. Issue 4 (3rd April 2023)

• Record Type: Journal Article
• Authors: Ray, Emily M.; Hinton, Sharon P.; Reeder-Hayes, Katherine E.
• Is Part Of: Medical care. Volume 61:Issue 4(2023)
• Page Start: 237
• Page End: 246
• Publication Date: 2023-04-03
• Subjects: lung cancer -- readmission -- health care utilization -- palliative care; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001829
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Advanced lung cancer (ALC) is a symptomatic disease often diagnosed in the context of hospitalization. The index hospitalization may be a window of opportunity to improve care delivery. Objectives: We examined the patterns of care and risk factors for subsequent acute care utilization among patients with hospital-diagnosed ALC. Research Design, Subjects, and Measures: In Surveillance, Epidemiology, and End Results-Medicare, we identified patients with incident ALC (stage IIIB–IV small cell or non–small cell) from 2007 to 2013 and an index hospitalization within 7 days of diagnosis. We used a time-to-event model with multivariable regression to identify risk factors for 30-day acute care utilization (emergency department use or readmission). Results: More than half of incident ALC patients were hospitalized around the time of diagnosis. Among 25, 627 patients with hospital-diagnosed ALC who survived to discharge, only 37% ever received systemic cancer treatment. Within 6 months, 53% had been readmitted, 50% had enrolled in hospice, and 70% had died. The 30-day acute care utilization was 38%. Small cell histology, greater comorbidity, precancer acute care use, length of index stay > 8 days, and prescription of a wheelchair were associated with higher risk of 30-day acute care utilization. Age >85 years, female sex, residence in South or West regions, palliative care consultation, and discharge to hospice or a facility were associated with lower risk. Conclusions: Many patients with hospital-diagnosed ALC experience an early return to the hospital and most die within 6 months. These patients may benefit from increased access to palliative and other supportive care during index hospitalization to prevent subsequent health care utilization.