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  • br Clinical Genitourinary Cancer June Table Regression

    2020-08-14


    Clinical Genitourinary Cancer June 2019 -  Table 3 Regression Estimates for Risk-Adjusted ED Visits, Risk-Adjusted Mortality, and Costs
    Characteristic ED Visits Within 30 Days ED Visits Within 365 Days Death Within 365 Days Total Costs Within 6 Months Total Costs Within 12 Months
    Stage
    Race
    White (ref)
    Urban/Rural Code
    Big metro (ref)
    Marital Status
    Married (ref)
    Histology
    Renal-cell carcinoma (ref)
    Charlson Comorbidity Score
    surgery
    surgerya
    Joel E. Segel et al
    Abbreviations: CI ¼ confidence interval; ED ¼ emergency department; OR ¼ odds ratio. aReceived within 30 days of surgery where outcome is measured at 30 days; and within 365-day outcomes for outcomes measured at 365 days after surgery.
    Risk-Adjusted ED Visits
    Abbreviations: CI ¼ confidence interval; ED ¼ emergency department.
    or coordination of subsequent care. Finally, while the OCM spe-cifically targets patients receiving systemic targeted therapy, this is relatively less common in kidney cancer so we focused on surgery as the primary index treatment.
    Conclusion
    While a hospital’s 30-day risk-adjusted ED visit rate may not be highly correlated with its risk-adjusted mortality rate or costs, it Geneticin likely remains an important outcome to collect, especially from a payer’s 
    perspective. Conversely, longer term ED visit rates were associated with significantly increased costs, even when excluding the cost of the ED visit. This may indicate that risk-adjusted ED visits can serve as an early warning sign of worsening health or that for a variety of reasons care coordination may need to be improved even if the visit may be less related to the initial surgery. Payers and providers should work together and share data to ensure that kidney cancer patients receive quality, long-term care coordination, especially as time passes since the initial surgery.
    Clinical Practice Points
    Older age, stage IV disease at diagnosis, and higher CCI score were all associated with significantly higher odds of a 30- or 365-day ED visit. A hospital’s risk-adjusted ED visit rate does not appear to be significantly correlated with its risk-adjusted mortality rate.
    A hospital’s 365-day risk-adjusted ED visit rate was associated with significantly higher costs; however 30-day ED visit rates were not associated with significantly higher costs.
    Disclosure
    The authors have stated that they have no conflicts of interest.
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