Keerat Grewal1, Rinku Sutradhar2, Monika K Krzyzanowska2, Donald A Redelmeier2, Clare L Atzema2. 1. Schwartz/Reisman Emergency Medicine Institute (Grewal), Sinai Health System; ICES (Grewal, Sutradhar, Krzyzanowska, Redelmeier, Atzema); University Health Network (Krzyzanowska); Sunnybrook Health Sciences Centre (Redelmeier, Atzema); Division of Emergency Medicine (Grewal, Atzema), Divisions of Medical Oncology and Hematology (Krzyzanowska), and Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto; Institute for Health Policy, Management & Evaluation (Sutradhar, Redelmeier, Atzema), University of Toronto, Toronto, Ont. keerat.grewal@sinaihealthsystem.ca. 2. Schwartz/Reisman Emergency Medicine Institute (Grewal), Sinai Health System; ICES (Grewal, Sutradhar, Krzyzanowska, Redelmeier, Atzema); University Health Network (Krzyzanowska); Sunnybrook Health Sciences Centre (Redelmeier, Atzema); Division of Emergency Medicine (Grewal, Atzema), Divisions of Medical Oncology and Hematology (Krzyzanowska), and Division of General Internal Medicine (Redelmeier), Department of Medicine, University of Toronto; Institute for Health Policy, Management & Evaluation (Sutradhar, Redelmeier, Atzema), University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: Patients with cancer have complex care requirements and frequently use the emergency department. The purpose of this study was to determine whether continuity of care, cancer expertise of an institution or both affect outcomes in patients with cancer in the emergency setting. METHODS: We conducted a retrospective cohort study using administrative databases from Ontario, Canada, involving records of patients aged 20 years and older who received chemotherapy or radiation in the 30 days before a cancer-related visit to the emergency department between 2006 and 2011. Patients seen in an emergency department at an alternative hospital (not the site where cancer treatment was given) were matched based on propensity score to patients who visited their original hospital (site where cancer treatment was given). Next, patients seen at an alternative emergency department that was in a general hospital (i.e., not a cancer centre) were matched to patients who visited their original hospital or a cancer centre. Outcomes were admission to hospital at the index visit to the emergency department, 30-day mortality, having imaging with computed tomography and return visits to the emergency department. RESULTS: We found 42 820 patients who were eligible for our study. Patients seen in the emergency departments at alternative hospitals were less likely to be admitted to hospital (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.74-0.83) and had higher hazards of return visits to the emergency department than matched patients at original hospitals (hazard ratio [HR] 1.06, 95% CI 1.03-1.11). In comparison, patients at alternative general hospitals also had lower odds of admission to hospital (OR 0.83, 95% CI 0.79-0.88) and higher hazards of return visits to the emergency department (HR 1.07, 95% CI 1.03-1.11) compared with matched counterparts; however, these patients had higher 30-day mortality (OR 1.13, 95% CI 1.05-1.22) and lower odds of having CT imaging (OR 0.74, 95% CI 0.69-0.80). INTERPRETATION: Cancer expertise of an institution rather than continuity of care may be an important predictor of outcomes following emergency treatment of patients with cancer.
BACKGROUND:Patients with cancer have complex care requirements and frequently use the emergency department. The purpose of this study was to determine whether continuity of care, cancer expertise of an institution or both affect outcomes in patients with cancer in the emergency setting. METHODS: We conducted a retrospective cohort study using administrative databases from Ontario, Canada, involving records of patients aged 20 years and older who received chemotherapy or radiation in the 30 days before a cancer-related visit to the emergency department between 2006 and 2011. Patients seen in an emergency department at an alternative hospital (not the site where cancer treatment was given) were matched based on propensity score to patients who visited their original hospital (site where cancer treatment was given). Next, patients seen at an alternative emergency department that was in a general hospital (i.e., not a cancer centre) were matched to patients who visited their original hospital or a cancer centre. Outcomes were admission to hospital at the index visit to the emergency department, 30-day mortality, having imaging with computed tomography and return visits to the emergency department. RESULTS: We found 42 820 patients who were eligible for our study. Patients seen in the emergency departments at alternative hospitals were less likely to be admitted to hospital (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.74-0.83) and had higher hazards of return visits to the emergency department than matched patients at original hospitals (hazard ratio [HR] 1.06, 95% CI 1.03-1.11). In comparison, patients at alternative general hospitals also had lower odds of admission to hospital (OR 0.83, 95% CI 0.79-0.88) and higher hazards of return visits to the emergency department (HR 1.07, 95% CI 1.03-1.11) compared with matched counterparts; however, these patients had higher 30-day mortality (OR 1.13, 95% CI 1.05-1.22) and lower odds of having CT imaging (OR 0.74, 95% CI 0.69-0.80). INTERPRETATION:Cancer expertise of an institution rather than continuity of care may be an important predictor of outcomes following emergency treatment of patients with cancer.
Authors: Nancy J O Birkmeyer; Philip P Goodney; Therese A Stukel; Bruce E Hillner; John D Birkmeyer Journal: Cancer Date: 2005-02-01 Impact factor: 6.860
Authors: Katherine Enright; Eva Grunfeld; Lingsong Yun; Rahim Moineddin; Mohammad Ghannam; Susan Dent; Andrea Eisen; Maureen Trudeau; Leonard Kaizer; Craig Earle; Monika K Krzyzanowska Journal: J Oncol Pract Date: 2015-01-20 Impact factor: 3.840
Authors: Tracy Onega; Eric J Duell; Xun Shi; Eugene Demidenko; Daniel Gottlieb; David C Goodman Journal: Med Care Res Rev Date: 2009-05-19 Impact factor: 3.929