Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Thomas Jefferson University, Philadelphia, PA.
JCO Clin Cancer Inform. 2021 Mar;5:266-271. doi: 10.1200/CCI.20.00146.
Acute care utilization (ACU), including emergency department (ED) visits or hospital admissions, is common in patients with cancer and may be preventable. The Center for Medicare & Medicaid Services recently implemented OP-35, a measure in the Hospital Outpatient Quality Reporting Program focused on ED visits and inpatient admissions for 10 potentially preventable conditions that arise within 30 days of chemotherapy. This new measure exemplifies a growing focus on preventing unnecessary ACU. However, identifying patients at high risk of ACU remains a challenge. We developed a real-time clinical prediction model using a discrete point allocation system to assess risk for ACU in patients with active cancer.
We performed a retrospective cohort analysis of patients with active cancer from a large urban academic medical center. The primary outcome, ACU, was evaluated using a multivariate logistic regression model with backward variable selection. We used estimates from the multivariate logistic model to construct a risk index using a discrete point allocation system.
Eight thousand two hundred forty-six patients were included in the analysis. ED utilization in the last 90 days, history of chronic obstructive pulmonary disease, congestive heart failure or renal failure, and low hemoglobin and low neutrophil count significantly increased risk for ACU. The model produced an overall C-statistic of 0.726. Patients defined as high risk (achieving a score of 2 or higher on the risk index) represented 10% of total patients and 46% of ACU.
We developed an oncology acute care risk prediction model using a risk index-based scoring system, the REDUCE (Reducing ED Utilization in the Cancer Experience) score. Further efforts to evaluate the effectiveness of our model in predicting ACU are ongoing.
癌症患者常因急性护理需求（acute care utilization，ACU）而就诊于急诊部（emergency department，ED）或住院，这是可以预防的。医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）最近实施了 OP-35，这是医院门诊质量报告计划（Hospital Outpatient Quality Reporting Program）中的一个措施，该措施主要针对化疗后 30 天内出现的 10 种潜在可预防的 ED 就诊和住院情况。这一新措施体现了人们对预防不必要的 ACU 的日益关注。然而，识别具有高 ACU 风险的患者仍然是一个挑战。我们使用离散点分配系统开发了一个实时临床预测模型，以评估处于活动期癌症患者的 ACU 风险。
我们对一家大型城市学术医疗中心的处于活动期癌症患者进行了回顾性队列分析。主要结局是 ACU，使用具有向后变量选择的多变量逻辑回归模型进行评估。我们使用多变量逻辑模型的估计值，使用离散点分配系统构建风险指数。
共纳入 8246 例患者。最近 90 天内 ED 就诊、慢性阻塞性肺疾病、充血性心力衰竭或肾衰竭病史、低血红蛋白和低中性粒细胞计数显著增加了 ACU 的风险。该模型产生的整体 C 统计量为 0.726。风险指数得分达到 2 分或以上（高风险）的患者占总患者的 10%，占 ACU 的 46%。
我们使用一种基于风险指数的评分系统（即 REDUCE 评分）开发了一种肿瘤急性护理风险预测模型。正在进一步努力评估我们的模型在预测 ACU 方面的有效性。
