Targeting preventable acute care events: A study on which patients experience emergency visits and hospitalizations during outpatient systemic therapy for cancer care.

Abstract

e13585 Background: Preventable acute care events within 30 days of systemic therapy administration (PACE30) represent significant clinical and economic burden in oncology. This study examined oncology patients who received outpatient systemic therapy administrations that resulted in PACE30 event, and sought to identify which patient segments had the largest opportunities for preventing such acute care events. Methods: Data from 190,629 outpatient systemic administrations given to 13,963 unique patients at Orlando Health between 2/17/2012 and 4/23/2021 were retrospectively examined. ICD9 and ICD10 codes were used to identify PACE30 events per CMS OP35 categories. Results: Of all treated patients, 35% had at least one acute care event within 30 days, 17% had at least one PACE30, with 7% patients having preventable emergency visit(s) and 12% patients having preventable hospitalization(s). Proportion of PACE30 events were examined by: Age group: 54% age 19-64, 37% age 65+, and 9.8% age < 18; Gender: 55% female, 45% male. Marital status: 41% not married, 59% married. Cancer type: 18% hematologic, 17% GI, 16% breast, 11% thoracic, and < 10% all others). Cancer stage: 63% metastatic, 37% non-metastatic. Systemic therapy type: 72% cytotoxic, 18% targeted therapy, 10% immunotherapy, and 6% endocrine therapy. Prior one year ED visit: 62% yes, 48% no. Prior one year hospitalization: 85% yes, 15% no. Prior pre-chemo vital signs: 97% normotensive, but 33% tachycardic, and 43% febrile. The PACE30 events were observed in the following categories: 39% pain, 23% sepsis, 12% fever, 11% neutropenia, 8% nausea, 8% pneumonia, 7% anemia, 4% diarrhea, 4% dehydration, and 3% vomiting. Conclusions: In this large cohort, 17% of patients experienced a preventable acute care event during their treatment course. Hematologic, GI and Breast primaries, particularly those with metastatic disease, accounted for the highest share of these events. Prior ED visit and especially prior hospitalizations dramatically increased risk for subsequent event. Notably, 43% had elevated temperature and 33% were tachycardic during at least one prior systemic therapy visit. By identifying and anticipating the needs of those patients with PACE30 events, clinical quality programs can develop systemic interventions to prevent these events more effectively.