Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
Int J Gynecol Cancer. 2021 Apr;31(4):585-593. doi: 10.1136/ijgc-2020-001520. Epub 2020 Oct 12.
Payment reform will give oncologists increasing responsibility for how patients with cancer meet unexpected care needs.
To differentiate how patients with gynecologic cancers use emergency care, and to assess the characteristics associated with potentially avoidable treat-and-release visits.
We performed a retrospective cohort study using the Nationwide Emergency Department Sample, a stratified sample of visits in United States hospital-based emergency departments, from 2010 to 2014. Visits by patients with a diagnosis of gynecologic cancer were selected. Sample weights were applied to calculate national estimates of care patterns and trends. Associations with treat-and-release disposition were assessed with weighted logistic regression.
In the study period, patients with gynecologic cancer made an estimated 370 104 annual emergency department visits (95% CI 351 997 to 388 211). A total of 50.2% of patients were treated and released, 48% were admitted, 1.6% were transferred, and 0.1% died. These visits corresponded to over US$1.27 billion in annual charges, with an average charge of US$3428 per visit (95% CI 3348 to 3509). Driven by growing treat-and-release utilization, annual visits increased, while admission rates fell over time. Patients with cervical cancer represented the plurality (36%) of visits; they were relatively younger, of lower socioeconomic status, and had fewer co-morbidities. Models for treat-and-release disposition did not vary significantly across different cancer populations. In the all-cancer model, increased odds of treat-and-release disposition was associated with cervical cancer diagnosis, younger age, lesser Elixhauser co-morbidity, Medicare coverage (OR=1.19; p<0.001), Medicaid coverage (OR=1.25; p<0.001), uninsured status (OR=1.70; p<0.001), and weekend visits. Visits in the northeast, at urban hospitals, and in winter months showed decreased odds of treat-and-release disposition.
Patients with gynecologic cancers have been using the emergency department at increasing rates, primarily driven by treat-and-release visits that did not result in admission or death. Patients with cervical cancer have higher rates of treat-and-release utilization and may over-use emergency department care.
支付改革将赋予肿瘤医生越来越多的责任，以满足癌症患者的意外护理需求。
区分妇科癌症患者如何使用急诊护理，并评估与潜在可避免的治疗后释放就诊相关的特征。
我们使用了全国急诊部样本进行回顾性队列研究，这是美国医院急诊部就诊的分层样本，时间范围为 2010 年至 2014 年。选择了患有妇科癌症诊断的患者就诊。应用样本权重计算护理模式和趋势的全国估计值。采用加权逻辑回归评估与治疗后释放处置相关的关联。
在研究期间，妇科癌症患者每年进行了约 370104 次急诊就诊（95%CI351997 至 388211）。共有 50.2%的患者接受治疗并出院，48%的患者被收治入院，1.6%的患者被转院，0.1%的患者死亡。这些就诊对应的年费用超过 12.7 亿美元，每次就诊的平均费用为 3428 美元（95%CI3348 至 3509）。由于治疗后释放的利用不断增加，每年的就诊量增加，而入院率随着时间的推移而下降。宫颈癌患者占就诊量的多数（36%）；他们相对较年轻，社会经济地位较低，合并症较少。不同癌症人群的治疗后释放处置模型没有显著差异。在所有癌症模型中，治疗后释放处置的可能性增加与宫颈癌诊断、年龄较小、较少的 Elixhauser 合并症、医疗保险覆盖（OR=1.19；p<0.001）、医疗补助覆盖（OR=1.25；p<0.001）、无保险状态（OR=1.70；p<0.001）和周末就诊有关。东北部、城市医院和冬季就诊的治疗后释放处置可能性降低。
妇科癌症患者的急诊就诊率一直在上升，主要是由于治疗后释放就诊未导致入院或死亡。宫颈癌患者的治疗后释放利用率较高，可能过度使用急诊护理。
