Early examination of national changes in potentially avoidable hospital visits after chemotherapy, 2018–2022.

Abstract

11096 Background: Medicare tallies potentially avoidable hospital visits after chemotherapy and has been publicly reporting this quality measure since 2018. The measure reports absolute visit rates for emergency department (ED) and inpatient admission (ADM), and generates relative comparisons to national rates (“better than”, “no different than”, “worse than”). We sought to identify changes in avoidable hospital visit rates through 2022. Methods: Retrospective analysis of avoidable hospital visit rates from 2018 – 2022, from a longitudinal cohort of hospitals in the Medicare Outpatient Quality Reporting Program. We performed descriptive and trend analysis for absolute visit rates and for relative performance. We stratified hospitals into quartiles of absolute performance in 2018, then applied multivariate generalized linear regression to model change in visit rates by 2022. We estimated the contribution of regression to the mean. Results: We analyzed 1,179 hospitals (23% teaching). National avoidable ED visit rates were 6.0% in 2018, 5.4% in 2022; ADM rates were 12.5% in 2018, 10.3% in 2022. Nearly all hospitals were deemed to have performed “no different” than the national rate each year for ED (≥ 95.3%) and ADM (≥ 91.1%). In adjusted analyses, visit rates for hospitals in the lowest 2018 visit rate quartiles declined the least by 2022 (ED: -0.44% 95% CI: -0.58 to -2.94; ADM: -0.91%, 95% CI: -1.14 to -0.69), but declined the most for hospitals in the highest 2018 quartiles (ED: -1.72%, 95% CI: -1.85 to -7.73; ADM: -3.03%, 95% CI: - 3.27 to -2.81). We estimated that regression to the mean accounted for a small proportion of the decline among the highest 2018 quartile of hospitals (ED: 10.6% of rate change, 95% CI: 9.8 to 11.5; ADM: 9.0%, 95% CI: 8.2 to 9.8). Conclusions: It appeared that nationally, and within quartiles of hospital performance, hospitals had improved their performance on this outpatient chemotherapy quality measure. Regression to the mean accounted for only a small proportion of this change, but the decline may reflect overall lower hospital visits post-COVID19 pandemic. Unadjusted Mean 2018 rate (SD) Unadjusted Mean 2022 rate (SD) Unadjusted mean absolute difference, 2022 – 2018 (SD) Adjusted absolute difference, 2022 – 2018 (95% CI) ED rate 0-25% (lowest rates) 5.00 (0.39) 5.06 (0.80) 0.07 (0.77) 0.18 (-0.14, 0.51) ED rate 26-50% 5.71 (0.14) 5.41(0.82) -0.29 (0.83) -0.44 (-0.58, -0.29)*** ED rate 51-75% 6.28 (0.20) 5.52 (0.89) -0.76 (0.89) -0.91 (-1.04, -0.77)*** ED rate 76-100% 7.36 (0.63) 5.85 (0.63) -1.51 (1.06) -1.72 (-1.86, -1.57)*** ADM rate 0-25% (lowest rates) 10.79 (0.66) 10.03 (1.35) -0.76 (1.35) -1.00 (-1.53, -0.49)*** ADM rate 26-50% 12.08 (0.28) 10.42 (0.29) -1.66 (1.31) -0.91 (-1.14, -0.69)*** ADM rate 51-75% 13.12 (0.36) 10.64 (1.38) -2.48 (1.41) -1.75 (-1.97, -1.52)*** ADM rate 76-100% 14.94 (1.02) 11.20 (1.52) -3.74 (1.58) -3.03 (-3.27, -2.81)*** ***p value <0.001.