Establishing regionalized acute care across a health care system to decentralize postoperative care after oncologic surgery Journal Article
| Authors: | Brauer, D. G.; Gonen, M.; Drebin, J. A.; Groeger, J. S.; Jewell, E. L. |
| Article Title: | Establishing regionalized acute care across a health care system to decentralize postoperative care after oncologic surgery |
| Abstract: | PURPOSEPatients undergoing oncologic surgery at major referral centers frequently experience postdischarge care fragmentation, which has been associated with poor outcomes. This report describes and evaluates the outcomes of an intervention at Memorial Sloan Kettering Cancer Center (MSKCC) to decentralize postdischarge postoperative acute care within our health care system.METHODSIn 2018, MSKCC completed the addition of six regional acute care clinics called symptom care clinics (SCCs) to existing regional outpatient clinics. Acute care was previously only available within our system at a single centralized urgent care center (UCC). All patients undergoing surgery in our system between January 1, 2019, and June 30, 2021, were followed for 90 days. The exposure was the site of initial acute care presentation - UCC or SCC - and outcomes included utilization, access, financial toxicity, and mortality. Mortality was adjusted using hierarchical modeling at the level of the region.RESULTSA total of 6,992 postsurgical patients experienced 10,525 acute care visits in our system within 90 days of surgery. Twenty-nine percent of these patients presented to the SCC first. These patients were older but had fewer comorbidities and shorter index length of stay compared with UCC patients. Utilization of SCCs increased substantially while UCC utilization decreased during a period of stable case volume. SCCs were closer to patients' homes, and wait times were shorter. Rates of financial toxicity were similar between groups. Of this high-risk cohort accessing acute care postoperatively, 90-day mortality was similar for UCC and SCC patients (P =.731).CONCLUSIONThis model of decentralized acute care after oncologic surgery was increasingly used over time with comparable patient safety. Health systems should emphasize patient-centered care by supporting safe strategies for regionalized care even when treatments are delivered at centralized referral centers. © American Society of Clinical Oncology. |
| Keywords: | adult; aged; middle aged; cancer surgery; major clinical study; clinical feature; plastic surgery; comparative study; postoperative care; prospective study; neoplasm; neoplasms; postoperative complication; health care utilization; length of stay; total quality management; urologic surgery; patient safety; comorbidity; outpatient department; surgical mortality; health care system; emergency care; hospital readmission; new york; centralization; gynecologic surgery; thorax surgery; breast surgery; health care delivery; regionalization; patient referral; health care access; delivery of health care; surgical patient; descriptive research; internist; clinical outcome; nurse; pandemic; physician assistant; home; humans; human; male; female; article; hierarchical clustering; high volume hospital; financial distress; advanced practice provider; icd-10; long covid; american society of anaesthesiologists score; patient triage; financial crisis; mskcc score; person centered care; decentralization |
| Journal Title: | JCO Oncology Practice |
| Volume: | 20 |
| Issue: | 5 |
| ISSN: | 2688-1527 |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2024-05-01 |
| Start Page: | 666 |
| End Page: | 672 |
| Language: | English |
| DOI: | 10.1200/op.23.00392 |
| PUBMED: | 38295332 |
| PROVIDER: | scopus |
| PMCID: | PMC11657752 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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