Comparing outcomes data from dedicated oncology-subspecialist hospitalists to those from a traditional care model on an inpatient oncology service.

Abstract

11538 Background: Changes in the complexity and delivery of health care and efforts to contain rising costs gave rise to the hospitalist model of care delivery in the 1990s. More recently some hospitals have begun using the hospitalist model on inpatient oncology floors. Oncology patients are a unique population who require high rates of hospitalization for problems arising from their progressive disease burden and side effects of cancer-directed therapy and have high rates of 30 day readmissions (30DR), an important quality metric. The majority of studies in this area have shown similar outcomes comparing care given by internal medicine hospitalists working full time on an inpatient oncology service compared to multiple oncologists working in rotating shifts on the same inpatient oncology service (Traditional). A new care model using dedicated hematology/oncology subspecialist hospitalists (H-O) to care for patients admitted to the oncology service has been implemented at our academic medical center. Methods: We conducted a retrospective chart review to identify patients with a cancer diagnosis admitted to the oncology service over a six year period. 7/1/2012-6/30/2015 marked the Traditional care model and 7/1/2015-7/1/2018 the H-O model. We compared 30DR, discharge to hospice, length of stay (LOS), and inpatient mortality between these two groups. Results: We identified a total of 3778 patients admitted to the oncology service over this six year period—1932 patients admitted to the Traditional service and 1846 patients admitted to the H-O service. There was a significant difference in 30DR between the Traditional v. H-O service (36.7% v. 29.5%, χ2= 21.1, p < 0.00001) and discharge to hospice (7.6% v. 12.9%, χ2= 29.0, p < 0.0000001). There was no significant difference in LOS between the Traditional and H-O services (6.40 days v. 6.03 days, p = 0.122) or in-hospital mortality (2.6% v. 1.9%, χ2= 2.16, p = 0.14). Conclusions: The shift to dedicated hospitalist-oncologists caring for patients on the inpatient oncology service significantly decreased 30DR at our institution. There were also significantly more patients transferred to hospice care. We found no significant difference between the two groups in LOS or inpatient mortality. This care model may help reduce the cost of caring for oncology patients by decreasing 30DR.