1 University of Texas Southwestern Medical Center, Dallas, TX.
2 Harold C. Simmons Comprehensive Cancer Center, Dallas, TX.
J Oncol Pract. 2019 Jun;15(6):e501-e509. doi: 10.1200/JOP.18.00743. Epub 2019 Apr 25.
Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer?
We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group. Our primary outcome was emergency department visits within 180 days after a cancer diagnosis, compiled as adjusted monthly rates of emergency department visits per 1,000 patient-months. We analyzed subsequent hospitalizations as a secondary outcome.
The rate of weekday emergency department visits was increasing at a rate of 0.43 visits (95% CI, 0.29 to 0.57 visits) per month before May 2012, then fell in half to a rate of 0.19 visits (95% CI, 0.11 to 0.28 visits) per month ( = .007) after the urgent care clinic was established. In contrast, the weekend visit rate was growing at a rate of 0.08 visits (95% CI, -0.03 to 0.19 visits) per month before May 2012 and 0.05 (95% CI, -0.02 to 0.13 visits; = .533) afterward. By the end of 2016, there were 15.3 fewer monthly weekday emergency department visits than expected ( = .005). Trends in weekday hospitalizations were not significantly changed.
Although only one in eight emergency department-visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.
专门为癌症患者设立的急症护理诊所是否会影响新诊断为癌症的成年人前往急症室就诊？
我们对在一家综合性癌症中心 2009 年至 2016 年间被诊断为癌症的 18 岁或以上成年人进行了每月调整的急症室就诊情况进行了一项中断时间序列分析。癌症登记患者与一个急症室和医院就诊的区域纵向数据库相关联。由于急症护理诊所周末关门，我们利用自然实验，将周末就诊作为对照组。我们的主要结果是癌症诊断后 180 天内的急症室就诊情况，以每 1000 患者月急诊就诊率的形式进行调整。我们分析了随后的住院情况作为次要结果。
在 2012 年 5 月之前，工作日的急诊就诊率以每月 0.43 次就诊（95%置信区间，0.29 至 0.57 次就诊）的速度增加，然后在建立急症护理诊所后减少一半，达到每月 0.19 次就诊（95%置信区间，0.11 至 0.28 次就诊）（ =.007）。相比之下，在 2012 年 5 月之前，周末就诊率每月增加 0.08 次就诊（95%置信区间，-0.03 至 0.19 次就诊），而之后每月增加 0.05 次就诊（95%置信区间，-0.02 至 0.13 次就诊； =.533）。到 2016 年底，每周工作日的急诊就诊量比预期减少了 15.3 次（ =.005）。工作日住院治疗的趋势没有明显变化。
尽管只有八分之一的急诊就诊患者也使用了急症护理诊所，但在该诊所成立后，急诊就诊的增长率下降了一半。
