Hay Casey M, Kelley Joseph L, Edwards Robert P, Pombier Kathleen M, Comerci John T
1 Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA.
Am J Med Qual. 2018 Sep/Oct;33(5):509-513. doi: 10.1177/1062860618757343. Epub 2018 Feb 20.
Super-utilizers account for many emergency department visits (EDV) and hospitalizations. Among Medicare/Medicaid patients, 5% to 10% account for >50% of spending. Little is known about super-utilization in gynecologic oncology. Charts of 64 gynecologic oncology patients with ≥3 EDV and/or admissions over 12 months were reviewed retrospectively. Cancer type distribution was 47% ovarian, 23% cervical, 23% endometrial, and 6% vulvar. Treatment at index visit was 61% chemotherapy, 16% no treatment, 8% recent surgery, and 6% radiation. Mean visits was 5.7 (SD 3.9, range 3-28). Most common presenting complaints were gastrointestinal and pain. Patients near end of life were more likely to be admitted. EDV frequently occurred outside standard work hours (63%). EDV/admissions resulted in total variable expenses of $1 462 581 ($982 933 direct expense, $479 648 service expense). Interventions to decrease super-utilization could target symptom management, off-hour support, patients on chemotherapy, and end of life. Approaches could include multidisciplinary resources, palliative care teams, extending office hours, and earlier initiation of hospice.
超级利用者占了许多急诊科就诊（EDV）和住院情况。在医疗保险/医疗补助患者中，5%至10%的人花费超过总支出的50%。关于妇科肿瘤学中的超级利用情况知之甚少。对64例在12个月内有≥3次急诊科就诊和/或住院的妇科肿瘤患者的病历进行了回顾性审查。癌症类型分布为卵巢癌47%、宫颈癌23%、子宫内膜癌23%、外阴癌6%。初次就诊时的治疗情况为化疗61%、未治疗16%、近期手术8%、放疗6%。平均就诊次数为5.7（标准差3.9，范围3 - 28）。最常见的就诊主诉是胃肠道问题和疼痛。接近生命末期的患者更有可能住院。急诊科就诊经常发生在标准工作时间之外（63%）。急诊科就诊/住院导致的总可变费用为1462581美元（直接费用982933美元，服务费用479648美元）。减少超级利用的干预措施可以针对症状管理、非工作时间支持、接受化疗的患者以及生命末期。方法可以包括多学科资源、姑息治疗团队、延长办公时间以及更早启动临终关怀服务。
