Whitney Robin L, Bell Janice F, Tancredi Daniel J, Romano Patrick S, Bold Richard J, Joseph Jill G
Robin L. Whitney, University of California, San Francisco, Fresno; and Robin L. Whitney, Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph, University of California, Davis, Sacramento, CA.
J Clin Oncol. 2017 Nov 1;35(31):3610-3617. doi: 10.1200/JCO.2017.72.4963. Epub 2017 Aug 29.
Purpose Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. Methods Individuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. Results In the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). Conclusion Individuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.
目的 在晚期癌症患者中，频繁住院越来越被视为低质量护理的一个标志。我们研究了晚期癌症患者在确诊后一年内的住院率以及再住院的个体和医院层面预测因素。方法 利用加利福尼亚癌症登记处（CCR）的数据，识别出2009年至2012年期间被诊断为晚期乳腺癌、结直肠癌、非小细胞肺癌或胰腺癌的个体（N = 25,032）。在与住院出院数据进行关联后，使用多状态和对数线性泊松回归模型来计算住院率，并对确诊后一年内的再住院情况进行建模，同时考虑生存率。结果 在确诊后的一年中，71%的晚期癌症患者住院，16%的患者有三次或更多次住院，64%的住院是从急诊科开始的。再住院率与非西班牙裔黑人（发病率比[IRR]，1.29；95%置信区间，1.17至1.42）和西班牙裔（IRR，1.11；95%置信区间，1.03至1.20）种族/族裔显著相关；公共保险（IRR，1.37；95%置信区间，1.23至1.47）和无保险（IRR，1.17；95%置信区间，1.02至1.35）；社会经济地位较低的五分位数（IRR，1.09至1.29）；合并症（IRR，1.13至1.59）；以及胰腺癌（IRR，2.07；95%置信区间，1.95至2.20）和非小细胞肺癌（IRR，1.69；95%置信区间，1.54至1.86）与结直肠癌相比。从设有门诊姑息治疗项目的医院出院后的再住院率显著较低（IRR，0.90；95%置信区间，0.83至0.97），而从营利性医院出院后的再住院率较高（IRR，1.33；95%置信区间，1.14至1.56）。结论 晚期癌症患者在确诊后的一年中经历了沉重的住院负担。减少住院并提供符合患者偏好的护理的努力可能针对风险较高的个体。未来的工作可能会探索晚期癌症患者获得社区姑息治疗的情况以及相关的医疗保健使用情况。
