Predictors of frequent emergency department visits among hospitalized cancer patients: a comparative cohort study using integrated clinical and administrative data to improve care delivery

• Published in: BMC health services research Vol. 23; no. 1; pp. 887 - 14
• Main Authors: Kurteva, Siyana, Tamblyn, Robyn, Meguerditchian, Ari N.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 22.08.2023; BioMed Central Ltd; BMC
• Subjects: Aged; Ambulatory Care - statistics & numerical data; Analgesics, Opioid - administration & dosage; Canada - epidemiology; Cancer; Cancer patients; Care and treatment; Chemotherapy; Chronic illnesses; Chronic pain; Cohort analysis; Cohort Studies; Cohort study; Comorbidity; Diabetes; Disease; Dosage and administration; Emergency department visits; Emergency medical care; Emergency service; Emergency Service, Hospital - statistics & numerical data; Female; Frequent users; Health Administration; Health care; Health Informatics; Health services; Hospitalization; Hospitals; Humans; Lung cancer; Male; Medicine; Medicine & Public Health; Narcotics; Neoplasms - drug therapy; Neoplasms - epidemiology; Nursing Research; Observational studies; Opioids; Patient Discharge; Patients; Pharmacy; Public Health; Risk; Canada; Quebec Canada; Emergency department visits; Frequent users; Cohort study; Cancer
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-09854-1

Background Frequent emergency department (FED) visits by cancer patients represent a significant burden to the health system. This study identified determinants of FED in recently hospitalized cancer patients, with a particular focus on opioid use. Methods A prospective cohort discharged from surgical/medical units of the McGill University Health Centre was assembled. The outcome was FED use (≥ 4 ED visits) within one year of discharge. Data retrieved from the universal health insurance system was analyzed using Cox Proportional Hazards (PH) model, adopting the Lunn-McNeil approach for competing risk of death. Results Of 1253 patients, 14.5% became FED users. FED use was associated with chemotherapy one-year pre-admission (adjusted hazard ratio (aHR) 2.60, 95% CI: 1.80–3.70), ≥1 ED visit in the previous year (aHR: 1.80, 95% CI 1.20–2.80), ≥15 pre-admission ambulatory visits (aHR 1.54, 95% CI 1.06–2.34), previous opioid and benzodiazepine use (aHR: 1.40, 95% CI: 1.10–1.90 and aHR: 1.70, 95% CI: 1.10–2.40), Charlson Comorbidity Index ≥ 3 (aHR: 2.0, 95% CI: 1.2–3.4), diabetes (aHR: 1.60, 95% CI: 1.10–2.20), heart disease (aHR: 1.50, 95% CI: 1.10–2.20) and lung cancer (aHR: 1.70, 95% CI: 1.10–2.40). Surgery (cardiac (aHR: 0.33, 95% CI: 0.16–0.66), gastrointestinal (aHR: 0.34, 95% CI: 0.14–0.82) and thoracic (aHR: 0.45, 95% CI: 0.30–0.67) led to a decreased risk of FED use. Conclusions Cancer patients with higher co-morbidity, frequent use of the healthcare system, and opioid use were at increased risk of FED use. High-risk patients should be flagged for preventive intervention.