Karovic Sanja, Dvergsten Erik, Pierattini Chiara, Barac Ana, Fay Lauren, Cannon Timothy L, Harnden Kathleen K, Aragon-Ching Jeanny B, Cuevo Raymund S, Maitland Michael L, Deeken John F
Inova Schar Cancer Institute, Fairfax, Virginia.
Inova Schar Heart and Vascular, Inova Health System, Falls Church, Virginia.
Cancer Res Commun. 2025 Jun 1;5(6):973-980. doi: 10.1158/2767-9764.CRC-24-0631.
The Centers for Medicare & Medicaid Services Hospital Outpatient Quality Reporting Program's OP-35 rule penalizes health systems that have a higher-than-expected rate of emergency department (ED) visits or inpatient admissions for 10 potentially preventable conditions within 30 days of receiving chemotherapy. Identifying patients at risk for toxicities and resultant acute care could lead to reducing the rate of such events, improving patient care, and reducing costs. We identified patients with cancer seen in the ED at our institution between January 1, 2018, and December 31, 2021, for one of the OP-35 toxicities who had received chemotherapy within the previous 30 days and analyzed demographic factors using zero-truncated Poisson regression. We further analyzed comorbid conditions for risk factors by matching by demographics and cancer type a cohort of patients without ED visits due to OP-35 events. A total of 1,618 patients were identified. The most frequent events were pain, sepsis, and fever. Thirty-nine percent had two or more visits during the study, and among those patients, the most frequent cancer types were gastrointestinal (32%) and breast (22%) cancers. Race, age, and sex were associated with an increased risk of events. In the matched cohort analysis, five comorbidities were statistically significant (P < 0.05) with event risk: history of coagulopathy/pulmonary emboli, myocardial infarction, cardiac arrhythmias, depression, and weight loss (concordance = 0.58). Forty-seven percent of patients with an event had at least one of these five comorbidities. Future interventions may concentrate on resources to monitor patients based on the risk assessment established in this study.
Cardiovascular comorbidities, cancer cachexia, and depression were associated with increased risk for ED visits due to OP-35 events throughout cancer treatment. Future interventions may concentrate on resources to monitor patients based on the risk assessment established in this real-world data study.
医疗保险和医疗补助服务中心医院门诊质量报告计划的OP - 35规则会对那些在接受化疗后30天内，因10种潜在可预防病症而出现高于预期的急诊科就诊率或住院率的医疗系统进行处罚。识别有中毒风险及由此导致急性护理需求的患者，可能会降低此类事件的发生率，改善患者护理并降低成本。我们确定了2018年1月1日至2021年12月31日期间在我院急诊科就诊、因OP - 35中毒之一且在过去30天内接受过化疗的癌症患者，并使用零截断泊松回归分析了人口统计学因素。我们通过按人口统计学和癌症类型匹配一组未因OP - 35事件而到急诊科就诊的患者，进一步分析了合并症的风险因素。共识别出1618名患者。最常见的事件是疼痛、败血症和发热。39%的患者在研究期间有两次或更多次就诊，在这些患者中，最常见的癌症类型是胃肠道癌（32%）和乳腺癌（22%）。种族、年龄和性别与事件风险增加相关。在匹配队列分析中，有五种合并症与事件风险具有统计学意义（P < 0.05）：凝血病/肺栓塞病史、心肌梗死、心律失常、抑郁症和体重减轻（一致性 = 0.58）。47%发生事件的患者至少有这五种合并症中的一种。未来的干预措施可能会集中于根据本研究建立的风险评估来监测患者的资源。
在整个癌症治疗过程中，心血管合并症、癌症恶病质和抑郁症与因OP - 35事件导致的急诊科就诊风险增加相关。未来的干预措施可能会集中于根据这项真实世界数据研究建立的风险评估来监测患者的资源。
