Targeting preventable acute care events: A study on reducing emergency visits and hospitalizations in outpatient chemotherapy administrations.

Abstract

e13584 Background: This study examined outpatient chemotherapy administrations that resulted in acute care events (ACE30) and preventable acute care events (PACE30) within 30 days of administration and sought to identify meaningful differences based on cancer type, chemotherapy type, age group, and the category of preventable event. The goal was to identify the largest opportunities of preventable acute care events to inform patient care. Methods: Data from 190,629 outpatient chemotherapy administrations given to 13,963 unique patients at Orlando Health between 2/17/2012 and 4/23/2021 were examined. Chemotherapy administrations were defined as any date where one or more outpatient chemotherapy medications were administered. ICD9 and ICD10 codes were used to identify PACE30 events per CMS OP35 categories. Proportions between all categories were examined to identify significant differences. Results: Of all chemo administrations, 8.7% had an ACE30, and of these 38% (3.3%) had a PACE30, resulting in 1.1% rate of preventable emergency visits and 2.2% rate of preventable hospitalizations. Risk for PACE30 was categorized as follows: By age: < 18 risk was (10.5%), 18-64 (2.9%), 65+ (2.6%) (p < 0.05). By cancer type: hematologic (5.3%), CNS/ H&N/ Thoracic/ GI/ GU/ Endocrine/ Connective Tissue were (3-4%), GYN/ Skin/ Misc (2-3%), breast cancer (1.9%) (p < 0.05). By cancer spread: non-metastatic (3.6%), metastatic (3.1%). By therapy type: cytotoxic chemotherapy (4.1%), targeted therapy (2.3%), immunotherapy (2.3%), endocrine therapy (1.2%) (p < 0.05). By prior year ED visit: no (3.1%), yes (3.3%) (p > 0.05). By prior year hospitalization: no (1.3%), yes (4.2%) (p < 0.05). The PACE30 events were pain (30.0%), sepsis (17.9%), neutropenia (12.4%), fever (11.6%), anemia (6.8%), nausea (6.2%), pneumonia (6.1%), diarrhea (3.4%), dehydration (3.1%), and vomiting (2.6%). Non-metastatic administrations had > 10% higher risk of neutropenia, while metastatic administrations had > 10% higher risk of pain. Conclusions: In this large data set, the probability of preventable acute care events was elevated in patients with age < 18, hematologic malignancies, those undergoing cytotoxic chemotherapy, or those with a prior hospitalization. Pain was the most common preventable event, especially for patients with metastatic disease. Managing pain appropriately in outpatient chemotherapy setting, whether treatment-related pain or cancer-pain, may result in rapid and significant reduction in preventable acute care events.