Pabon Cindy M, Wong Janine, Perez Marcela, Jimenez-Abarca Jessica, Xiao Lianchun, Jackson Lymesia, Park Anne, Lankford Anjali, Akula Vinita, Datar Saumil, Hopper Taylor, Alkhatib Yaser, Earles Terri, Patel Tejal
General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Accreditation & Regulatory Affairs, Harris Health System, Houston, Texas, USA.
BMJ Open Qual. 2025 Feb 13;14(1):e003068. doi: 10.1136/bmjoq-2024-003068.
Patients with advanced cancers visit the emergency room and get hospitalised frequently, with potentially half of these visits being avoidable. Our institution provides comprehensive, low-cost cancer treatment to a safety-net population in Texas. We performed a retrospective review of hospital readmission patterns amongst our oncology patients and developed a posthospitalisation workflow to reduce readmissions.
Following discharge, oncology patients were risk stratified based on their Length of stay, Acuity of admission, Charlson comorbidity index score and Emergency department visits+index in the past 6 months. The higher the score, the quicker the outpatient oncology follow-up. In addition to addressing acute issues related to hospitalisation, patients were also able to receive newly translated resources while in clinic.
The preintervention 30-day-readmission rate was 17.3% (June 2022-December 2022) (95% CI 13.4% to 21.8%). Meanwhile, the postintervention 30-day-readmission rate was 14.7% (June 2023-December 2023) (95% CI 10.9% to 19.2%). While a 2.6% reduction in readmissions was achieved, this decrease was not statistically significant (-2.6%; 95% CI -8.4% to 3.2%; p value=0.375). Emergency use utilisation decreased from 90% to 15%.
Our team was able to facilitate and coordinate outpatient care for oncology patients following hospitalisation. The expedited care allowed providers to ensure that the care plan after hospitalisation was well understood and accessible to the patient. Furthermore, language-appropriate resources were provided to patients at that time. Our intervention was feasible, easy to implement and quick to produce tangible improvements in patient care. More time is needed to determine whether this will create a statistically significant impact on readmission rates.
晚期癌症患者经常前往急诊室并频繁住院，其中可能有一半的就诊是可以避免的。我们的机构为德克萨斯州的安全网人群提供全面、低成本的癌症治疗。我们对肿瘤患者的医院再入院模式进行了回顾性研究，并制定了出院后工作流程以减少再入院率。
出院后，根据肿瘤患者的住院时间、入院急症程度、查尔森合并症指数评分以及过去6个月内的急诊科就诊次数+指数对其进行风险分层。分数越高，门诊肿瘤随访越快。除了解决与住院相关的急性问题外，患者在诊所时还能够获得新翻译的资源。
干预前30天再入院率为17.3%（2022年6月至2022年12月）（95%置信区间13.4%至21.8%）。同时，干预后30天再入院率为14.7%（2023年6月至2023年12月）（95%置信区间10.9%至19.2%）。虽然再入院率降低了2.6%，但这一降低在统计学上并不显著（-2.6%；95%置信区间-8.4%至3.2%；p值=0.375）。急诊使用率从90%降至15%。
我们的团队能够促进和协调肿瘤患者出院后的门诊护理。快速的护理使医护人员能够确保患者充分理解出院后的护理计划并能够实施。此外，当时还为患者提供了适合其语言的资源。我们的干预措施可行、易于实施且能迅速在患者护理方面产生切实改善。需要更多时间来确定这是否会对再入院率产生统计学上的显著影响。
