In a new study based in a California health care system, slightly over one-fifth of patients with newly diagnosed hematologic malignancies had unplanned acute care visits within 30 days of index hospitalization for their initial diagnosis. Details and results of the study were reported in JCO Clinical Cancer Informatics.
The study also shed light on risk factors associated with unplanned 30-day acute care utilization in patients following an initial diagnosis of a hematologic malignancy using electronic medical records (EMRs) obtained from a health care system. The health care system was a nonprofit, community-based system in southern California. Patients who were included in the retrospective study had been admitted to 3 acute care inpatient locations within this system between 2012 and 2017.
A total of 933 patients were evaluated and they had a mean age of 65 years. Nearly half (48.7%) had a lymphoma diagnosis, 35.2% had a leukemia diagnosis, 14.0% had a myeloma diagnosis, and 2.1% had a diagnosis of other/mixed types.
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Unplanned acute care services were used within 30 days of discharge by 21.2% of the patients. Index hospitalizations tended to be shorter, with fewer days in the intensive care unit, and with less severe illness than these later admissions were.
Over half (56.6%) of the patients who had unplanned acute care visits within 30 days of discharge presented with at least 1 symptom or complication identified using a medical complication measure developed by the Centers for Medicare and Medicaid Services for patients who receive outpatient chemotherapy. These symptoms and complications were related to disease progression or effects of treatment.
In initial predictive model development, the strongest predictors overall for unplanned 30-day acute care utilization included a briefer initial hospital stay, a lack of social work consultation, a history of counseling or medication for behavioral health issues, and illness severity.
Further exploration revealed that low creatinine clearance (<97 mL/min in men and <88 mL/min in women) appeared to be a risk factor; 59.6% of patients who had unplanned 30-day acute care utilization had low creatinine clearance, compared with 52.7% of patients who did not have unplanned acute care visits after discharge.
Each type of hematologic malignancy appeared associated with its own set of risk factors for the study outcome of unplanned 30-day acute care utilization. This outcome was predicted by initial illness severity, male sex, shorter length of stay, and certain laboratory results in patients with leukemia.
In patients with lymphoma, lack of social work consultation, steroid therapy with chemotherapy, and history of counseling or behavioral health medications were predictive factors. For patients with myeloma, lack of social work consultation, history of substance use, certain laboratory results, and fall risk assessment were risk factors for unplanned 30-day acute care utilization.
“In conclusion, this study analyzed real-world EMR data to gain insights into patient-related factors that might help inform a proactive approach, beginning with the identification of patients who are at greater risk for unplanned acute care service utilization,” the study investigators wrote in their report.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Reference
Zu K, Greenwood KL, LaMori JC, Smith B, Smith T, Lee A. Factors associated with unplanned acute care services for patients with newly diagnosed hematologic malignancies. JCO Clin Cancer Inform. 2021;5:1197-1206. doi:10.1200/CCI.21.00110
