In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. 6548-6548
Abstract:
6548 Background: ICU admissions in the last 30 days of life are an indicator of poor care. Our prior research found nearly half of terminal oncology ICU hospitalizations are potentially avoidable. Methods: Data were derived from 72 patients consecutively cared for in an academic medical center’s oncology practice who died in an ICU between July 1, 2012 and June 30, 2013. Oncologists, intensivists, and hospitalists used a standardized assessment tool to review each patient’s electronic health record from 3 months prior to hospitalization until death; they made a clinical determination of avoidability. Two investigators, blinded to the specialty, used a grounded theory approach to extract clinical themes associated with the reviewer’s determination of avoidability. Total, direct, and indirect costs were abstracted for each avoidable hospitalization. Results: Thirty-four (47%) of the examined hospitalizations were deemed avoidable. The primary themes associated with avoidability, and the percentage by specialty, were as follows: 1) failure to initiate appropriate advance care planning in the outpatient setting (68% oncologists, 55% intensivists, 65% hospitalists), 2) failure to integrate understanding of limited prognosis (23% oncologists, 24% intensivists, 26% hospitalists), and 3) failure of clinical management (6% oncologists, 21% intensivists, 6% hospitalists). A failure to educate and integrate surrogates into timely medical decision-making was a prominent secondary theme for oncologists (22%), intensivists (18%), and hospitalists (29%). The total cost per patient averaged $44,532 with direct and indirect costs averaging $25,215 and $19,317, respectively. High cost areas were ICU level care (35%) and pharmaceuticals (16%). Conclusions: The themes identified suggest potential preventative interventions, including higher rates of outpatient advance care planning, oncology inpatient communication to promote patient’s prognostic understanding, prevention of failures in clinical management, and better education and integration of surrogates. Given 8% of oncology patients expire in the ICU and 47% were identified as avoidable, the potential national annual cost of these avoidable hospitalizations is $997MM.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/JCO.2017.35.15_suppl.6548
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2017
detail.hit.zdb_id:
2005181-5
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