Identification of Potentially Avoidable Hospitalizations in Patients With GI Cancer
Identification of Potentially Avoidable Hospitalizations in Patients With GI Cancer
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DOI：
10.1200/jco.2013.52.4330
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发表时间：
2014-02-20
影响因子：
45.3
通讯作者：
Schrag, Deborah
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文献类型：
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作者：
Brooks, Gabriel A.;Abrams, Thomas A.;Schrag, Deborah
目的识别和表征潜在的可避免的住院治疗的患者与GI malignances.Patients和方法，我们编制了一个回顾性系列的顺序入院治疗的患者与GI癌症。患者在2011年12月至2012年7月期间接受住院肿瘤内科或姑息治疗服务。执业肿瘤临床医生使用共识驱动的病历审查过程，将每次住院分为潜在可避免或不可避免。患者的人口统计学和临床数据进行了抽象，并进行定量和定性分析，以确定患者的特点和结果与潜在的可避免的hospitalizations.Results相关，我们评估了201住院154个独特的患者。中位年龄为62岁，结直肠癌是最常见的诊断（32%）。大多数住院患者患有转移性癌症（81%）。总的来说，53%的住院是由于癌症症状，28%是由于癌症治疗的并发症。医学肿瘤学家确定了39例住院治疗（19%）可能是可以避免的。对于具有以下特征的患者，住院更可能被归类为潜在可避免的：年龄70岁（比值比[OR]，2.63; 95% CI，1.15 - 6.02），接受肿瘤科医生建议考虑临终关怀（OR，6.09; 95%CI，2.54至14.58），或接受三线或三线以上化疗（OR，2.68; 95%CI，1.01至7.08）。90天死亡率较高后，可避免的住院治疗相比，不可避免的住院治疗（OR，6.4; 95%CI，1.8至22.3）。大多数潜在可避免的住院治疗发生在晚期难治性癌症患者中，这些患者接近生命的尽头。(C)2014年美国临床肿瘤学会
Purpose To identify and characterize potentially avoidable hospitalizations in patients with GI malignancies.Patients and Methods We compiled a retrospective series of sequential hospital admissions in patients with GI cancer. Patients were admitted to an inpatient medical oncology or palliative care service between December 2011 and July 2012. Practicing oncology clinicians used a consensus-driven medical record review process to categorize each hospitalization as potentially avoidable or not avoidable. Patient demographic and clinical data were abstracted, and quantitative and qualitative analyses were performed to identify patient characteristics and outcomes associated with potentially avoidable hospitalizations.Results We evaluated 201 hospitalizations in 154 unique patients. The median age was 62 years, and colorectal cancer was the most common diagnosis (32%). The majority of hospitalized patients had metastatic cancer (81%). In all, 53% of hospitalizations were attributable to cancer symptoms, and 28% were attributable to complications of cancer treatment. Medical oncologists identified 39 hospitalizations (19%) as potentially avoidable. Hospitalizations were more likely to be categorized as potentially avoidable for patients with the following characteristics: age 70 years (odds ratio [OR], 2.63; 95% CI, 1.15 to 6.02), receipt of an oncologist's advice to consider hospice (OR, 6.09; 95% CI, 2.54 to 14.58), or receipt of three or more lines of chemotherapy (OR, 2.68; 95% CI, 1.01 to 7.08). Ninety-day mortality was higher after avoidable hospitalizations compared with hospitalizations that were not avoidable (OR, 6.4; 95% CI, 1.8 to 22.3).Conclusion Potentially avoidable hospitalizations are common in patients with advanced GI cancer. The majority of potentially avoidable hospitalizations occurred in patients with advanced treatment-refractory cancers near the end of life. (C) 2014 by American Society of Clinical Oncology