Identification of healthcare vulnerabilities associated with unplanned hospital care in Black patients with pancreas cancer.

Abstract

e18572 Background: Black patients with pancreatic cancer are underrepresented in clinical trials and have worse outcomes than other patients. A retrospective analysis we conducted of 658 patients with pancreatic cancer identified that Black patients are 2.8x more likely to have recurrent ED visits than non-Black patients. This finding motivated this study of Black patients with pancreas cancer who had ED visits over a two-month period to better understand the causal factors that predispose this population to higher rates of unplanned hospital care. Methods: A quality improvement pilot study of Black patients with pancreas cancer who had ED visits between 12/06/22-02/06/23 was conducted. Computational identification of this cohort was performed using a novel Power BI dashboard that tracks health system encounters by patients with pancreas cancer using ICD10 C25 as a cohort identifier in daily updates. Each ED visit then prompted a phone call to the patient from an African American oncology nurse practitioner who served as a cultural translator to evaluate their healthcare vulnerabilities. Demographic and clinical features were recorded from the EMR. Median household income was extrapolated by zip code using data from the US Census Bureau. Results: During this two-month period, 14 Black patients had at least 1 ED visit. Of these, 50% had ≥2 ED visits during this timeframe. Through retrospective review, we found that patients in this cohort had an average of 4.4 ED visits in the past year. The cohort was 50% male with a mean age of 65.5 years and median household income of $67,032. 21% have commercial insurance, 36% have Medicaid, and 43% have Medicare. 86% established care with a primary care physician and 71% established care with a medical oncologist. 79% of patients did not have a social work assessment in their charts. We were unable to reach 50% of patients in this cohort at their preferred phone numbers. Of the patients we connected with: 71% note their highest level of education as high school, 29% do not feel safe in their communities, 14% lack a reliable support system, and 57% experience financial insecurity. Conclusions: We observed a substantial burden of ED visits among Black patients. Remarkably, half of the patients already required a second ED visit during the two-month span of this project. Given these intriguing results, we intend to pursue a prospective study using a validated questionnaire to better understand and address the factors that lead to these ED visits.