Augmentation of cancer outcomes through safe transitions.

Abstract

250 Background: Policymakers have identified 30-day readmissions as an important quality indicator of poor care or coordination of care. Among cancer centers, there is no benchmark data in terms of readmission rates or recommendations in terms of risk adjustment models. Methods: Retrospective data analysis to estimate baseline readmission rate and identify risk factors. Interventions: (1)admitting to single floor, (2) twice weekly interdisciplinary meetings with using risk assessment tool–Cancer Outcomes Augmented through Safe Transitions (COAST) tool, and (3) re-evaluate readmission rate post intervention at 6 months and 1 year. Results: Unplanned readmission rate on the Hospitalist Service at MD Anderson was 21.5% at baseline. After 6 months of interventions, our readmission rate over 6 months was 23.3%. Age 45-65, having Medicare insurance, and being discharged to hospice were protective of a readmission. Distant metastases and having more comorbidities were associated with increased risk for readmission. Readmitted patients have a greater length of stay (7 days) and a higher average cost of inpatient stay ($20.3K vs. 17.9K). The median days to readmission was 11 days. Top comorbidities: hypertension, fluid and electrolyte disorders, anemia, diabetes mellitus, and abnormal weight loss. Top reasons: metastatic disease, biliary tract disease, GI hemorrhage, intestinal obstruction, septicemia, renal failure. Conclusions: Our project has provided insight into the rates and risk factors for readmission in oncology hospitalist service in a tertiary cancer center. The development of web-based COAST risk assessment tool is expected to give an improved understanding of our patient population. Although our readmission rates have not shown decrease over the 6 months after our interventions, this means that more interventions and more time may be necessary to impact readmission rates of services dealing with complex cancer patients. Additionally, a proportion of these unplanned readmissions in cancer patients may not be preventable. Benchmark data we have presented and that we continue to collect will help inform recommendations for effective transitions of care, patient safety practices as well as strategies for reducing readmission rates in cancer centers.