PCN362 EMERGENCY DEPARTMENT UTILIZATION ASSOCIATED WITH RAPID ACCESS PALLIATIVE MEDICINE CONSULTATION

Abstract

Cancer patients visit the emergency department (ED) more than non-cancer patients and commonly report pain as the main reason for ED use. ED staff are not trained to manage cancer-related symptoms. Levine Cancer Institute (LCI) implemented a rapid access service (RAS) for patients with poorly control cancer symptoms aimed at reducing ED visits. Solid tumor cancer patients who reported pain symptoms at an outpatient visit in 2018 were included. Patient demographics, stage, disease site, and payer status were obtained from Atrium Health’s cancer registry. ED utilization 30-days prior to and post pain symptom reporting were obtained via the institutional data warehouse for patients who received RAS consultation or not. Results were summarized descriptively, and logistic regression analysis was used to assess difference in ED utilization among RAS and non-RAS groups. Parsimonious multivariable models were constructed by univariate selection and backward elimination. Treatment (RAS vs non-RAS) by ED utilization (≥2 vs <2 visits before reporting pain symptoms/RAS consultation) and treatment by stage interaction terms were estimated to assess differential impacts of RAS. All analyses were conducted in SAS 9.4 (Cary, NC). 852 patients met the inclusion criteria (n = 138 RAS). The population’s mean age was 60. Approximately 60% were female; 71% were white; 32% had breast or female genital cancers; 27% had gastrointestinal cancer; 17% had respiratory cancer; 10% had urinary cancer; 57% had advanced-stage cancer (stage 3 and 4). Roughly 51% were Medicare/Medicaid beneficiaries. Advanced stage patients who used RAS had decreased odds of being high ED utilizers (OR: 0.25, p = 0.023) post RAS visit as compared with others who didn’t use RAS and/or local stage patients. RAS consultation is associated with a decrease in ED visits for advanced stage cancer patients. Further exploration on association of RAS and inpatient admission and unscheduled outpatient visits is warranted.