scholarly journals Toxicity-Related Factors Associated With Use of Services Among Community Oncology Patients

2016 ◽  
Vol 12 (8) ◽  
pp. e818-e827 ◽  
Author(s):  
Jordan M. Harrison ◽  
Philip J. Stella ◽  
Beth LaVasseur ◽  
Paul T. Adams ◽  
Lauren Swafford ◽  
...  
Keyword(s):  
Emergency Department ◽  
Service Use ◽  
Health Care Service ◽  
Emergency Department Visits ◽  
Survey Study ◽  
Related Factors ◽  
Factors Associated ◽  
Community Oncology ◽  
Ambulatory Oncology ◽  
Patient Reported

Purpose: Community oncology practices frequently manage chemotherapy-associated toxicities, which may disrupt treatment, impair quality of life, and induce unplanned service use. We sought to understand the patterns and correlates of unplanned health care service use among patients receiving first-cycle chemotherapy at five community-based ambulatory oncology practices. Patients and Methods: A survey study examined the dichotomous outcome of unplanned service use, defined as oncologist visits, emergency department visits, and hospitalizations, resulting from toxicity-related factors. Newly diagnosed patients with breast, lung, head and neck, or colorectal cancer or non-Hodgkin lymphoma were recruited during the first chemotherapy cycle. Before beginning the second cycle of chemotherapy, patients completed a questionnaire that measured unplanned service use and overall distress, plus severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problems, pain, fever and chills, extremity edema, and dyspnea on a 5-point scale (1, did not experience; 5, disabling). Medical record reviews captured chemotherapy doses, comorbid conditions, and supportive care interventions. Mixed-effects logistic regression was used to identify factors associated with unplanned service use, with random effects specified for each clinic. Results: Among 106 patients (white, 98%; female, 74.5%; mean age ± standard deviation, 60 ± 11 years), frequently reported toxicities were pain, nausea, diarrhea, and constipation. Thirty-six patients (34%) reported unplanned service use: 29% reported oncologist visits, 14% reported emergency department visits, and 8% reported hospitalizations. Factors significantly associated with unplanned service use were high patient-reported distress and receipt of colony-stimulating factor. Conclusion: Service use resulting from toxicity-related factors occurs frequently in community oncology settings. Monitoring toxicity patterns and outcomes can inform proactive symptom management approaches to reduce toxicity burden between scheduled visits.

Factors associated with toxicity-related service use among community oncology patients.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 133-133 ◽  
Author(s):  
Jordan M Harrison ◽  
Beth Lavasseur ◽  
Philip J. Stella ◽  
Paul T. Adams ◽  
Lauren Swafford ◽  
...  
Keyword(s):  
Service Use ◽  
Total Sample ◽  
Emergency Department Visits ◽  
Assessment Tools ◽  
Point Scale ◽  
Factors Associated ◽  
Community Oncology ◽  
Ambulatory Oncology ◽  
Patient Reported ◽  
Related Service

133 Background: Chemotherapy-associated toxicities occur often, yet sparse data are available to correlate toxicities with related service use. Toxicities may disrupt treatment, impair quality of life, and induce unplanned service use. We sought to understand the frequency and correlates of unplanned service use among patients receiving first-cycle chemotherapy at 5 community-based ambulatory oncology practices in southeast Michigan. Methods: A prospective survey examined the dichotomous outcome of toxicity-related unplanned service use. Newly-diagnosed patients were recruited before the first chemotherapy cycle. At the second cycle visit, patients completed a questionnaire that measured severity of nausea, vomiting, diarrhea, constipation, mouth sores, IV catheter problems, pain, fever/chills, extremity edema, and dyspnea on a 5-point scale (1 = did not experience to 5 = disabling). They also rated distress on a 10-point scale (0 = none, 10 = worst). Patients reported unplanned oncologist visits, emergency department visits, and unplanned hospitalizations, all of which were treated as unplanned service use. Mixed-effects logistic regression was used to identify factors associated with unplanned service use, with random effects for each clinic. Results: Among 106 patients (98% white, 74.5% women, mean age 60+11), common diagnoses were breast, lung, and colorectal cancer and non-Hodgkin lymphoma. Frequent toxicities were pain, nausea, diarrhea, and constipation. Thirty-six patients (34%) reported unplanned service use: 29% reported oncologist visits, 14% reported ED visits, and 8% reported hospitalizations. 45% of the total sample and 89% of patients with unplanned service use reported at least one toxicity that was severe or disabling. Factors associated with unplanned service use were high patient-reported distress and receipt of colony-stimulating factor. Conclusions: Toxicity-related service use was common in this community oncology population. Proactive symptom assessment tools may help clinicians manage toxicities between visits. A deeper understanding of toxicity patterns and correlates can inform clinical practice guidelines in community oncology practices.

Frequency and burden of patient-reported chemotherapy toxicities in community-based oncology practices.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 178-178
Author(s):  
Christopher Ryan Friese ◽  
Philip J. Stella ◽  
Beth Lavasseur ◽  
Paul T. Adams ◽  
Lauren Swafford ◽  
...  
Keyword(s):  
Emergency Department ◽  
Service Use ◽  
Care Delivery ◽  
Care Service ◽  
Health Care Service ◽  
Management Strategies ◽  
Emergency Department Visits ◽  
Trial Participation ◽  
Community Based ◽  
Patient Reported

178 Background: Patient-reported outcomes measurement is recommended to improve care delivery. Toxicities are important to study given their impacts on treatment completion. We captured patient-reported toxicities in community-based oncology practices and identified toxicities associated with excess health care service use. Methods: We surveyed newly-diagnosed patients who completed their first chemotherapy cycle at 5 community practices. Exclusion criteria were prior cancer history, non-English speakers, psychiatric diagnosis, and clinical trial participation. At the second cycle return visit, patients completed a questionnaire that measured the severity of nausea, vomiting, diarrhea, constipation, mouth sores, intravenous catheter problem, pain, fever/chills, extremity edema, and dyspnea. These were rated on a 5-point scale (1= did not experience to 5 = very severe). Patients also reported unscheduled oncologist visits, emergency department visits, or inpatient hospitalization. Results: Of 117 eligible patients, 106 (91%) participated. Most patients (98%) were white, 25.5% were male, and the mean(SD) age was 60 (11) years. The most frequent diagnoses were breast (43%), lung (21%), colorectal cancer (13%), and non-Hodgkin lymphoma (13%). Between cycle 1 and 2, frequent severe or very severe toxicities were nausea (30%), pain (18%), diarrhea (9%), and mouth sores (9%). 15% of patients had an unscheduled oncologist visit, 18% had an emergency department visit, and 9% of patients were admitted. Nausea (11.3%) and diarrhea (6.6%) were frequent reasons for unscheduled oncology visits; nausea and pain (both 5%) for emergency department visits, and; pain and dyspnea (both 2%) for hospitalization. Conclusions: Patient-reported toxicity monitoring is feasible and informative in community-based oncology practices. Despite widespread antiemetic use, nausea is a pervasive problem for newly-treated patients and drives excess service use. Pain assessment and management strategies are needed to reduce emergency department visits and hospitalizations.

scholarly journals Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Axel Kaehne ◽  
Paula Keating
Keyword(s):  
Emergency Department ◽  
Service Use ◽  
Emergency Department Visits ◽  
Service Utilisation ◽  
Specific Patient ◽  
Access Points ◽  
Latent Demand ◽  
Frequent Attenders ◽  
Cohort Design ◽  
The Impact

Abstract Background Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. Method The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. Results ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. Conclusion The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.

scholarly journals COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

2020 ◽  
Vol 47 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Maria Bres Bullrich ◽  
Sebastian Fridman ◽  
Jennifer L. Mandzia ◽  
Lauren M. Mai ◽  
Alexander Khaw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Emergency Department Visits ◽  
Related Factors ◽  
Hospital Policies ◽  
The Government ◽  
Stroke Center ◽  
The Impact ◽  
Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

Factors associated with bariatric postoperative emergency department visits

2016 ◽  
Vol 12 (10) ◽  
pp. 1826-1831 ◽  
Author(s):  
Ryan Macht ◽  
Judy George ◽  
Omid Ameli ◽  
Donald Hess ◽  
Howard Cabral ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Factors Associated

scholarly journals Patient- and Surgery-Related Factors that Affect Patient-Reported Outcomes after Total Hip Arthroplasty

2018 ◽  
Vol 7 (10) ◽  
pp. 358 ◽  
Author(s):  
Toshiyuki Kawai ◽  
Masanao Kataoka ◽  
Koji Goto ◽  
Yutaka Kuroda ◽  
Kazutaka So ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Activity Score ◽  
Harris Hip Score ◽  
Related Factors ◽  
Ucla Activity Score ◽  
Factors Associated ◽  
Total Hip ◽  
Patient Reported

Patient-reported outcome measures (PROMs) are used to assess satisfaction after total hip arthroplasty (THA); however, the factors that determine these PROMs remain unclear. This study aimed to identify the patient- and surgery-related factors that affect patient satisfaction after THA as indicated by the Oxford Hip Score (OHS). One-hundred-and-twenty patients who underwent primary THA were included. Various patient-related factors, including clinical scores, and surgery-related factors were examined for potential correlations with the OHS at 3, 6, and 12 months post-THA. Univariate regression analysis showed that higher preoperative University of California Los Angeles (UCLA) activity score (p = 0.027) and better preoperative OHS (p = 0.0037) were correlated with better OHS at 3 months post-THA. At 6 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.039), better preoperative OHS (p = 0.0006), and use of a cemented stem (p = 0.0071). At 12 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.0075) and better preoperative OHS (p < 0.0001). Multivariate regression analysis showed that the factors significantly correlated with better OHS were female sex (p = 0.011 at 3 months post-THA), osteoarthritis (p = 0.043 at 6 months), higher preoperative OHS (p < 0.001 at 3 and 12 months, p = 0.018 at 6 months), higher preoperative Harris Hip Score (p = 0.001 at 3 months), higher preoperative UCLA activity score (p = 0.0075 at 3 months), and the use of a cemented femoral component (p = 0.012 at 6 months). Patient- and surgery-related factors affecting post-THA PROMs were identified, although the effect of these factors decreased over time.

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