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

Eugene D. Kreys, Ted Y. Kim, Andrew Delgado, Jim M. Koeller

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

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 (GCSFs), 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.

Original languageEnglish (US)
Pages (from-to)168-173
Number of pages6
JournalJournal of Oncology Practice
Volume10
Issue number3
DOIs
StatePublished - May 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

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