Peter May1, Melissa M Garrido2, Melissa D Aldridge3, J Brian Cassel4, Amy S Kelley3, Diane E Meier3, Charles Normand5, Joan D Penrod3, Thomas J Smith6, R Sean Morrison2. 1. Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland; Icahn School of Medicine at Mount Sinai, New York, New York. 2. Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters VA Medical Center, New York, New York. 3. Icahn School of Medicine at Mount Sinai, New York, New York. 4. Virginia Commonwealth University, Richmond, Virginia. 5. Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland. 6. Johns Hopkins Medical Institutions, Baltimore, Maryland.
Abstract
BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers. PATIENTS: Adults with advanced cancer admitted to a participating hospital between 2007 and 2011, excluding those with dementia. Final analytic sample included 1020 patients. METHODS: With receipt of palliative care controlled for, the associations between hospital cost and patient factors were estimated. Factors covered the domains of demographics (age, sex, race), socioeconomics and systems (education, insurance, living will, proxy), clinical care (diagnoses, complications deemed to pose a threat to life or bodily functions, comorbidities, symptom burden, activities of daily living), and prior healthcare utilization (home help, analgesic prescribing). OUTCOME MEASURE: Direct hospital costs. RESULTS: A major (markedly abnormal) complication (+$8267; P < 0.01), a minor but not a major complication (+$5289; P < 0.01), and number of comorbidities (+$852; P < 0.01) were associated with higher cost, and admitting diagnosis of electrolyte disorders (-$4759; P = 0.01) and increased age (-$53; P = 0.03) were associated with lower cost. CONCLUSIONS: Complications and comorbidity burden drive inhospital utilization for adults with advanced cancer. There is little evidence of sociodemographic associations and no apparent impact of advance directives. Attempts to control growth of hospital cancer costs require consideration of how the most resource-intensive patients are identified promptly and prioritized for cost-effective care. Journal of Hospital Medicine 2017;12:407-413.
BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers. PATIENTS: Adults with advanced cancer admitted to a participating hospital between 2007 and 2011, excluding those with dementia. Final analytic sample included 1020 patients. METHODS: With receipt of palliative care controlled for, the associations between hospital cost and patient factors were estimated. Factors covered the domains of demographics (age, sex, race), socioeconomics and systems (education, insurance, living will, proxy), clinical care (diagnoses, complications deemed to pose a threat to life or bodily functions, comorbidities, symptom burden, activities of daily living), and prior healthcare utilization (home help, analgesic prescribing). OUTCOME MEASURE: Direct hospital costs. RESULTS: A major (markedly abnormal) complication (+$8267; P < 0.01), a minor but not a major complication (+$5289; P < 0.01), and number of comorbidities (+$852; P < 0.01) were associated with higher cost, and admitting diagnosis of electrolyte disorders (-$4759; P = 0.01) and increased age (-$53; P = 0.03) were associated with lower cost. CONCLUSIONS: Complications and comorbidity burden drive inhospital utilization for adults with advanced cancer. There is little evidence of sociodemographic associations and no apparent impact of advance directives. Attempts to control growth of hospital cancer costs require consideration of how the most resource-intensive patients are identified promptly and prioritized for cost-effective care. Journal of Hospital Medicine 2017;12:407-413.
Authors: Joan D Penrod; Melissa M Garrido; Karen McKendrick; Peter May; Melissa D Aldridge; Diane E Meier; Katherine A Ornstein; R Sean Morrison Journal: J Palliat Med Date: 2017-06-19 Impact factor: 2.947
Authors: Jafar Al-Mondhiry; Sarah D'Ambruoso; Christopher Pietras; Thomas Strouse; Dikla Benzeevi; Armen C Arevian; Kenneth B Wells Journal: JMIR Form Res Date: 2022-06-23
Authors: Cara L McDermott; Ruth A Engelberg; James Sibley; Mohamed L Sorror; J Randall Curtis Journal: J Palliat Med Date: 2020-03-16 Impact factor: 2.947
Authors: Arianne Brinkman-Stoppelenburg; Suzanne Polinder; Branko F Olij; Barbara van den Berg; Nicolette Gunnink; Mathijs P Hendriks; Yvette M van der Linden; Daan Nieboer; Annemieke van der Padt-Pruijsten; Liesbeth A Peters; Brenda Roggeveen; Frederiek Terheggen; Sylvia Verhage; Maurice J van der Vorst; Ingrid Willemen; Yvonne Vergouwe; Agnes van der Heide Journal: Eur J Cancer Care (Engl) Date: 2019-12-11 Impact factor: 2.520