Emergency department use by recently diagnosed cancer patients in California
Background Improving the quality of cancer care and reducing preventable health system use are goals of increasing importance to health practitioners and policy makers. Emergency department (ED) visits are often cited as a source of preventable health system use, however, few studies have described the incidence of ED use by recently diagnosed cancer patients in population-based samples, and no study has addressed the full spectrum of cancer types.
Objective To describe ED use by recently diagnosed cancer patients.
Methods California Office of Statewide Health Planning and Development data and the California Cancer Registry were used to describe ED use in the year after a cancer diagnosis (2009-2010). The incidence of ED use was tabulated by cancer type. Logistic regression and recycled predictions were used to examine ED use adjusting for confounding factors.
Results Most ED visits (68%) occurred within 180 days of diagnosis. The incidence of ED use for all cancer types examined was 17% within 30 days, 35% within 180 days and 44% within 365 days of diagnosis. ED use varied by cancer type (5%-39% within 30 days of diagnosis; 14%-62% within 180 days; and 22%-69% within 365 days). Patterns of ED use by cancer type remained similar after accounting for demographic and socioeconomic factors.
Limitations Those common to administrative and registry datasets. Specifically, we were unable to account for ED visits in relation to cancer treatment dates and comorbid conditions.
Conclusions Cancer patients use EDs at higher rates than previously reported, with considerable variability by cancer type. Future research should examine reasons for ED visits by cancer type and identify predictors of ED use, including treatment and comorbid conditions.
Funding/sponsorship The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors.
Accepted for publication January 20, 2017
Correspondence Rebecca S Lash, PhD; rebeccaslash@gmail.com
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2017;15(2):95-102
©2017 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0334
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Limitations
The limitations of this study include those common to use of administrative and registry data and the CCR and OSHPD data in particular. While CCR data are known to be complete with respect to demographic and cancer information, treatment data is less robust and specific treatment dates are not available.14,34 As a result, we were unable to analyze ED use in relation to receipt of outpatient treatment. As we included all ED visits on or up to a year after the day of diagnosis, it is possible that our analysis includes diagnoses that occurred in conjunction with an ED visits. However, it is unlikely a reporting hospital would report a cancer diagnosis to the CCR without a corresponding hospital admission. Therefore, we assume such cases to be rare.
Lastly, California had lower prevalence of health insurance coverage and higher market penetration by health maintenance organizations, relative to the national average, which may limit the generalizability of the results to other states.35 At the same time, CCR-OSHPD linked data offer the advantage of providing complete data to enumerate ED visits among patients whether they were discharged home or subsequently admitted to hospital.
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