Opportunities for better management of cancer in patients receiving chemotherapy at Aurora Health Care (AHC), a large integrated health system in eastern Wisconsin.

Abstract

110 Background: Cancer patients, especially those on chemotherapy, have complex medical histories. They experience a variety of medical problems from their cancer and treatments. This quality improvement study is designed to collect information about chemotherapy related emergency department (ED) visits to estimate ED utilization rates, recognize patterns and evaluate other confounders. The goal is to assess and reduce ED use at AHC through improved care management. Methods: The one-year data analysis includes any patient who received chemotherapy in an outpatient care setting and had a visit to the ED within 60 days of treatment. Chemotherapy was defined by designated CPT codes combined with a primary cancer diagnosis. Every ED visit was matched to all available chemotherapy visits for each patient, retaining the chemotherapy visit nearest in chronology prior to the ED visit. Data Exclusions: (a) Patients who received chemotherapy outside AHC, and then accessed an AHC ED; (b) Patients who received inpatient chemotherapy. Results: There were 28,738 chemotherapy encounters for 4,264 unique patients system-wide. AHC EDs saw 1,669 visits for 1,048 unique patients within 60 days of chemotherapy (24.6%). The top three cancer diagnoses were 21% thoracic; 21% GI; and 16% lymph/hematopoietic. Of the 1,669 ED visits, 35% occurred within seven days and 77% within 30 days of treatment. Almost half (45.6%) of the ED visits occurred during normal office hours. No significant variation was noted by day of week. An initial focus was on the tertiary center which represented 318 (20%) of the 1,669 ED visits. The most common diagnoses for an ED visit were pain (17%) and deconditioning (17%), followed by infection (11%) and respiratory symptoms (11%). Conclusions: This study documents the ED utilization by AHC chemotherapy patients. Unexpectedly, ED use occurred frequently during normal office hours. Most visits were represented by a limited number of cancer diagnoses and presenting complaints. Intervention is planned to reduce ED use after chemotherapy at AHC through improved patient education and by shifting these visits to less expensive venues when possible.