Impact of cancer supportive care pathways compliance on emergency department visits and hospitalizations.

Abstract

PURPOSE:

To evaluate the effects of compliance to cancer supportive care pathways on emergency department (ED) visits and hospitalizations as a result of neutropenia, anemia, and chemotherapy-induced nausea and vomiting (CINV).

METHODS:

CareFirst claims database was used to evaluate data spanning 2 years of the clinical pathways program. Frequency of ED visits/hospitalizations for neutropenia, anemia, and CINV were compared between compliant and noncompliant pathway utilization of granulocyte colony-stimulating factors (G-CSFs), erythropoiesis-stimulating agents (ESAs), and antiemetics, respectively. Logistic regression analysis was used to control for drug expenditures and cancer types.

RESULTS:

A total of 4,144 lines of therapy were received by 3,191 patients from 46 practices across three states. Overall, there were 472 ED visits/hospitalizations for neutropenia, 34 visits for anemia, and 799 visits for CINV. G-CSF pathway-compliant treatment was associated with a significant reduction in neutropenia ED visits/hospitalizations compared with noncompliant treatment (odds ratio [OR] = 0.34; 95% CI, 0.25 to 0.45; P < .001). Adjusting for cancer type and G-CSF drug expenditures, a similar reduction in neutropenia ED visits/hospitalizations was observed (OR = 0.42; 95% CI 0.30 to 0.58; P < .001). Analogous analyses did not demonstrate a significant association between ESA and antiemetic pathway compliance and ED visits/hospitalizations for anemia (P = .069) and CINV (P = .106), respectively. G-CSF therapy pathway compliance was also associated with an average decrease of $1,085 in ED visit/hospitalization costs per line of therapy (P < .001).

CONCLUSION:

G-CSF pathway compliance was associated with a significant decrease in the rate of neutropenia ED visits/hospitalizations and resulting costs.

• Authors: Eugene D Kreys, Ted Y Kim, Andrew Delgado, Jim M Koeller
• Journal: Journal of oncology practice (J Oncol Pract) Vol. 10 Issue 3 Pg. 168-73 (May 2014) ISSN: 1935-469X [Electronic] United States
• PMID: 24839275 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 by American Society of Clinical Oncology.

Chemical References

• Antineoplastic Agents
• Hematinics
• Granulocyte Colony-Stimulating Factor

Topics

• Antineoplastic Agents (adverse effects, therapeutic use)
• Breast Neoplasms (drug therapy)
• Colorectal Neoplasms (drug therapy)
• Emergency Service, Hospital
• Granulocyte Colony-Stimulating Factor (economics, therapeutic use)
• Hematinics (economics, therapeutic use)
• Hospitalization (economics, statistics & numerical data)
• Humans
• Lung Neoplasms (drug therapy)
• Medication Adherence
• Neutropenia (chemically induced, economics, prevention & control)
• Palliative Care
• Retrospective Studies