In a single-institution study reported in JCO Oncology Practice, Gould Rothberg et al found that establishment of a dedicated cancer urgent care center within a large tertiary academic center resulted in a significant but modest decrease in emergency department use—but no significant reduction in hospitalization rates—among patients with cancer receiving active care.
Study Details
The Oncology Extended Care Clinic (OECC) is a six-bed facility established at Smilow Cancer Hospital, the clinical arm of the Yale Cancer Center. Rates of all emergency department presentations and hospital admissions during the 3-month window following the index provider visit were compared for a 4-month period after a 5-month run-in following OECC opening (post-OECC period) vs the same 4 calendar months in the year prior to opening (pre-OECC period).
Key Findings
The study cohorts consisted of 2,095 patients in the pre-OECC period and 2,188 in the post-OECC period.
In the pre-OECC period, 466 patients made 682 emergency department visits (72.7% with a single visit) and 546 patients had 863 hospitalizations. In the post-OECC period, 447 patients made 618 emergency department visits (73.2% with a single visit) and 567 patients had 833 hospitalizations. Among hospitalizations, 468 (54.2%) resulted from an emergency department visit during the pre-OECC period and 430 (51.6%) resulted from an emergency department visit during the post-OECC period.
For the pre-OECC vs post-OECC periods, there were 32.6 vs 28.2 emergency department visits/100 patients, made by 22.2% vs 20.4% of patients, and 41.2 vs 26.1 hospitalizations/100 patients, for 26.1% vs 25.9% of patients.
In analysis adjusted for age, race, ethnicity, sex, and practice location, the difference in rates per 100 patients for the post-OECC vs pre-OECC periods were:
- -4.6 (95% confidence interval [CI] = -8.92 to -0.28, P = .04) for all emergency department visits
- -3.29 (95% CI = -8.24 to 1.67, P = .19) for all hospital admissions
- -1.93 (95% CI = -4.38 to 0.52, P = .12) for individual patients with an emergency department visit
- -0.20 (95% CI = -2.80 to 2.43, P = .89) for individual patients with a hospital admission.
The investigators concluded, “Establishing a cancer-specific urgent care center was significantly associated with a modest decrease in emergency room utilization but not with hospitalization rate. Barriers included clinic capacity, patient awareness, and physician comfort with advanced practice provider autonomy. Optimizing workflow and standardizing clinical pathways can create benchmarks useful for value-based payments.”
Bonnie E. Gould Rothberg, MD, PhD, MPH, of the Smilow Oncology Extended Care Clinic, Smilow Cancer Hospital at Yale-New Haven Health, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by Smilow Cancer Hospital Internal Funds for Quality Improvement. For full disclosures of the study authors, visit ascopubs.org.
