1 University of California, San Francisco, Fresno, CA.
2 University of California, Davis, Sacramento, CA.
J Oncol Pract. 2019 Jan;15(1):e20-e29. doi: 10.1200/JOP.18.00254. Epub 2018 Dec 5.
Reducing acute care use is an important strategy for improving value in cancer care. However, little information is available to describe and compare population-level hospital use across cancer types. Our aim was to estimate unplanned hospitalization rates and to describe the reasons for hospitalization in a population-based cohort recently diagnosed with cancer.
California Cancer Registry data linked with administrative inpatient data were used to examine unplanned hospitalization among individuals diagnosed with cancer between 2009 and 2012 (n = 412,850). Hospitalizations for maintenance chemotherapy, radiotherapy, or planned surgery were excluded. Multistate models were used to estimate age-adjusted unplanned hospitalization rates, accounting for survival.
Approximately 67% of hospitalizations in the year after diagnosis were unplanned, 35% of newly diagnosed individuals experienced an unplanned hospitalization, and 67% of unplanned hospitalizations originated in the emergency department (ED). Nonmalignancy principal diagnoses most frequently associated with unplanned hospitalization included infection (15.8%) and complications of a medical device or care (6.5%). Unplanned hospitalization rates were highest for individuals with hepatobiliary or pancreatic cancer (2.08 unplanned hospitalizations per person-year at risk), lung cancer (1.58 unplanned hospitalizations), and brain or CNS cancer (1.47 unplanned hospitalizations), and were lowest among individuals with prostate cancer (0.18 unplanned hospitalizations) and melanoma (0.25 unplanned hospitalizations).
The population burden of unplanned hospitalization among individuals newly diagnosed with cancer is substantial. Many unplanned hospitalizations originate in the ED and are associated with potentially preventable admission diagnoses. Efforts to reduce unplanned hospitalization might target subgroups at higher risk and focus on the ED as a source of admission.
减少急性护理的使用是提高癌症护理价值的重要策略。然而，关于癌症类型的人群层面的医院使用情况，可获得的信息很少。我们的目的是评估新诊断癌症人群的非计划性住院率，并描述住院的原因。
利用加利福尼亚癌症登记处的数据与行政住院数据进行关联，以检查 2009 年至 2012 年间诊断患有癌症的个体（n=412850）的非计划性住院情况。排除维持化疗、放疗或计划手术的住院治疗。使用多状态模型来估计调整年龄后的非计划性住院率，同时考虑生存情况。
诊断后一年约有 67%的住院是计划性外的，35%的新诊断患者经历了计划性外的住院治疗，67%的计划性外住院治疗来自急诊科（ED）。与计划性外住院治疗最常相关的非恶性主要诊断包括感染（15.8%）和医疗器械或护理相关并发症（6.5%）。非计划性住院率最高的是患有肝胆或胰腺癌症（2.08 次/人年）、肺癌（1.58 次/人年）和脑或中枢神经系统癌症（1.47 次/人年）的个体，而前列腺癌（0.18 次/人年）和黑色素瘤（0.25 次/人年）患者的非计划性住院率最低。
新诊断癌症患者的计划性外住院人群负担很大。许多计划性外住院治疗源于急诊科，与潜在可预防的入院诊断有关。减少计划性外住院的努力可能需要针对高风险亚组，并将急诊科作为入院的来源。
