scholarly journals The Effect of Comorbidity Burden on Health Care Utilization for Patients with Cancer Using Hospice

2011 ◽  
Vol 14 (6) ◽  
pp. 751-756 ◽  
Author(s):  
Aron Legler ◽  
Elizabeth H. Bradley ◽  
Melissa D.A. Carlson
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Patients With Cancer ◽  
Comorbidity Burden

scholarly journals Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study (Preprint)

2018 ◽  
Author(s):  
Kah Poh Loh ◽  
Erika Ramsdale ◽  
Eva Culakova ◽  
Jason H Mendler ◽  
Jane L Liesveld ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Symptom Burden ◽  
Mobile App ◽  
Care Utilization ◽  
Intervention Period ◽  
Patients With Cancer ◽  
System Usability Scale

BACKGROUND Older patients with cancer are at an increased risk of adverse outcomes. A geriatric assessment (GA) is a compilation of reliable and validated tools to assess domains that are predictors of morbidity and mortality, and it can be used to guide interventions. However, the implementation of GA and GA-driven interventions is low due to resource and time limitations. GA-driven interventions delivered through a mobile app may support the complex needs of older patients with cancer and their caregivers. OBJECTIVE We aimed to evaluate the feasibility and usability of a novel app (TouchStream) and to identify barriers to its use. As an exploratory aim, we gathered preliminary data on symptom burden, health care utilization, and satisfaction. METHODS In a single-site pilot study, we included patients aged ≥65 years undergoing treatment for systemic cancer and their caregivers. TouchStream consists of a mobile app and a Web portal. Patients underwent a GA at baseline with the study team (on paper), and the results were used to guide interventions delivered through the app. A tablet preloaded with the app was provided for use at home for 4 weeks. Feasibility metrics included usability (system usability scale of >68 is considered above average), recruitment, retention (number of subjects consented who completed postintervention assessments), and percentage of days subjects used the app. For the last 8 patients, we assessed their symptom burden (severity and interference with 17-items scored from 0-10 where a higher score indicates worse symptoms) using a clinical symptom inventory, health care utilization from the electronic medical records, and satisfaction (6 items scored on a 5-point Likert Scale for both patients and caregivers where a higher score indicates higher satisfaction) using a modified satisfaction survey. Barriers to use were elicited through interviews. RESULTS A total of 18 patients (mean age 76.8, range 68-87) and 13 caregivers (mean age 69.8, range 38-81) completed the baseline assessment. Recruitment and retention rates were 67% and 80%, respectively. The mean SUS score was 74.0 for patients and 72.2 for caregivers. Mean percentage of days the TouchStream app was used was 78.7%. Mean symptom severity and interference scores were 1.6 and 2.8 at preintervention, and 0.9 and 1.5 at postintervention, respectively. There was a total of 27 clinic calls during the intervention period and 15 during the postintervention period (week 5-8). One patient was hospitalized during the intervention period (week 1-4) and two patients during the postintervention period (week 5-8). Mean satisfaction scores of patients and caregivers with the mobile app were 20.4 and 23.4, respectively. Barriers fell into 3 themes: general experience, design, and functionality. CONCLUSIONS TouchStream is feasible and usable for older patients on cancer treatment and their caregivers. Future studies should evaluate the effects of the TouchStream on symptoms and health care utilization in a randomized fashion.

Evaluation of Oncology Hospital at Home: Unplanned Health Care Utilization and Costs in the Huntsman at Home Real-World Trial

2021 ◽  
pp. JCO.20.03609
Author(s):  
Kathi Mooney ◽  
Karen Titchener ◽  
Benjamin Haaland ◽  
Lorinda A. Coombs ◽  
Brock O'Neil ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Care Utilization ◽  
Patients With Cancer ◽  
Hospital Stays ◽  
Hospital At Home ◽  
Unplanned Hospitalizations ◽  
Care Costs ◽  
At Home

PURPOSE Patients with cancer experience high rates of morbidity and unplanned health care utilization and may benefit from new models of care. We evaluated an adult oncology hospital at home program's rate of unplanned hospitalizations and health care costs and secondarily, emergency department (ED) use, length of hospital stays, and intensive care unit (ICU) admissions during the 30 days after enrollment. METHODS We conducted a prospective, nonrandomized, real-world cohort comparison of 367 hospitalized patients with cancer—169 patients consecutively admitted after hospital discharge to Huntsman at Home (HH), a hospital-at-home program, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for HH admission, but those in usual care lived outside the HH service area. Primary outcomes were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, ICU admissions, and ED visits during the 30 days after enrollment. RESULTS Groups were comparable except that more women received HH care. In propensity-weighted analyses, the odds of unplanned hospitalizations was reduced in the HH group by 55% (odds ratio, 0.45, 95% CI, 0.29 to 0.70; P < .001) and health care costs were 47% lower (mean cost ratio, 0.53; 95% CI, 0.39 to 0.72; P < .001) over the 30-day period. Secondary outcomes also favored HH. Total hospital stay days were reduced by 1.1 days ( P = .004) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI, 0.33 to 0.92; P = .022). There was no evidence of a difference in ICU admissions ( P = .972). CONCLUSION This oncology hospital at home program shows initial promise as a model for oncology care that may lower unplanned health care utilization and health care costs.

The Impact of Depression on Health Care Utilization in Patients with Cancer

2021 ◽  
Author(s):  
Star Ye ◽  
Courtney P. Williams ◽  
Aidan D. Gilbert ◽  
Chao-Hui Huang ◽  
Terri L. Salter ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Patients With Cancer ◽  
The Impact

Effect of the Serious Illness Care Program on Health Care Utilization at the End of Life for Patients with Cancer

2020 ◽  
Vol 23 (10) ◽  
pp. 1365-1369
Author(s):  
Joanna Paladino ◽  
Luca Koritsanszky ◽  
Brandon J. Neal ◽  
Joshua R. Lakin ◽  
Jane Kavanagh ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Care Program ◽  
Care Utilization ◽  
Serious Illness ◽  
Patients With Cancer

scholarly journals Comparison of Health Care Utilization at the End of Life Among Patients With Cancer in Alberta, Canada, Versus Washington State

2020 ◽  
Vol 16 (12) ◽  
pp. e1543-e1552
Author(s):  
Ali Raza Khaki ◽  
Yuan Xu ◽  
Winson Y. Cheung ◽  
Li Li ◽  
Catherine Fedorenko ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
The United States ◽  
Washington State ◽  
Care Utilization ◽  
Patients With Cancer ◽  
Ed Visits ◽  
Eol Care

PURPOSE: Aggressive care at the end of life (EOL) can lead to unnecessary suffering and health care costs for patients with cancer. Despite geographic proximity and cultural similarities, we hypothesize that EOL care is more intense in the United States multipayer system versus the Canadian single-payer system. We compared health care utilization at EOL among patients with cancer in Alberta, Canada, with those in Washington state in the United States. METHODS: Adult patients with American Joint Committee on Cancer stage II to IV solid tumors who died between 2014 and 2016 in Alberta and between 2015 and 2017 in Washington were identified from regional population-based cancer registries linked to treatment and hospitalization records (Alberta) and health claims from major regional insurance plans (Washington). The proportion of patients receiving chemotherapy and having multiple emergency department (ED) visits, or intensive care unit (ICU) admissions in the last 30, 60, and 90 days of life (DOL) in Alberta and Washington were determined and compared using two-sample z-test and multivariable logistic regression (α = .006 after Bonferroni correction). RESULTS: Of patients, 11,177 in Alberta and 12,807 in Washington were included. Patients were similar in age (median, 71 v 72 year), with more patients in Washington with no comorbidities. More patients in Washington were treated with chemotherapy (12.6% v 6.6%; adjusted OR [aOR], 2.74), had multiple ED visits (16.2% v 12.1%; aOR, 1.40), and ICU admissions (23.7% v 3.9%; aOR, 14.27) in the last 30 DOL. Utilization was also higher in Washington in the last 60 and 90 DOL and among those with stage IV disease and those age 65 years and older. CONCLUSION: Utilization of chemotherapy, ED visits, and ICU admissions near EOL was higher in Washington versus Alberta. Future studies to characterize drivers of aggressive EOL care may help improve cancer care for patients in the United States and Canada.

Impact of diabetes and hyperglycemia on health care utilization, infection risk, and survival in patients with cancer receiving glucocorticoids with chemotherapy.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 19-19
Author(s):  
Dylan M. Zylla ◽  
Grace Gilmore ◽  
Justin Eklund ◽  
Sara Richter ◽  
Anders Carlson
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Urgent Care ◽  
Care Utilization ◽  
Intravenous Chemotherapy ◽  
Logistic Regression Models ◽  
Patients With Cancer ◽  
One Year ◽  
The Impact

19 Background: Glucocorticoid (GC) use is commonly used in chemotherapy regimens and may lead to hyperglycemia and increased infection rates. We assessed the impact of diabetes (DM) and hyperglycemia on rates of health-care utilization, infections and survival among patients with cancer receiving chemotherapy. Methods: We performed a retrospective analysis on 1,781 patients who received intravenous chemotherapy with GC between 2010 and 2015. Demographic, clinical, and health-care utilization (HCU) data was obtained using electronic medical record, billing modules, and the tumor registry; HCU included tallies of emergency room, urgent care, and inpatient visits. Logistic regression models were used to compare survival and new infections between patients with and without DM, after adjusting for demographic and cancer-related variables. Results: In the first 12 months following chemotherapy, patients with DM (n = 330) had higher rates of hospital admissions (70.9% vs 57.4%, p< 0.001), more infection-related admissions (37.0% vs 29.2%, p = 0.007), and increased rates of new infections (61.2% vs 49.2%, p < 0.001) when compared to patients without DM (n = 1,451). One-year survival rate was worse among patients with DM (67.3% vs 78.3%, p < 0.001), as well as patients with at least one glucose reading above 300 mg/dL following chemotherapy (60.8% vs 78.5, p < 0.001). After adjusting for cancer stage, age, and gender, we found DM history increased the odds of dying within one year after diagnosis by 86% (OR 1.86, 95% CI (1.37 – 2.52), p < 0.001) and of new infections by 68% (OR 1.68, 95% CI (1.26 – 2.24), p < 0.001). Conclusions: Among patients with cancer receiving intravenous chemotherapy with GC we demonstrate patients with DM have more hospital admissions, increased rates of infections, and worse survival. Prospective studies are urgently needed to elucidate what level of glycemic control is needed to potentially improve outcomes for patients with DM receiving chemotherapy with GC.

scholarly journals Type D personality is associated with increased comorbidity burden and health care utilization among 3080 cancer survivors

2012 ◽  
Vol 34 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Floortje Mols ◽  
Simone Oerlemans ◽  
Johan Denollet ◽  
Jan-Anne Roukema ◽  
Lonneke V. van de Poll-Franse
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Cancer Survivors ◽  
Type D Personality ◽  
Care Utilization ◽  
Type D ◽  
Comorbidity Burden
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