30-day-or-sooner readmissions of gastrointestinal medical oncology patients following cancer center inpatient service discharge: Characteristics and preventability Journal Article

Authors: Epstein, A. S.; Crosbie, C.; Martin, S. C.; Egan, B.; Goring, T. N.; Koo, D. J.; Kumar, C. B.; Salvit, C.; Capanu, M.; Chou, J.; Saltz, L. B.
Article Title: 30-day-or-sooner readmissions of gastrointestinal medical oncology patients following cancer center inpatient service discharge: Characteristics and preventability
Abstract: PURPOSE: The Centers for Medicare and Medicaid Services recently initiated readmission reduction programs for certain noncancer index admissions. Intrinsic to this policy is the assumption that such readmissions are reasonably preventable and are due to inadequate management. For cancer patients, readmission frequency, characteristics, and their preventability have not been extensively evaluated. METHODS: We first electronically searched medical records of patients on our gastrointestinal oncology inpatient service to identify patients who had been discharged and then readmitted within 30 days. However, electronic review resulted in insufficient granularity of clinical records. Therefore, 50 of them were randomly selected for exhaustive manual review to assess the reasons for index admission and readmission, the nature of the index admission discharge plan, and whether the readmission was reasonably preventable or not, based on prespecified criteria. RESULTS: Between September 1, 2008, and March 1, 2013, 3995 gastrointestinal medical oncology patients had an index admission, of whom 876 (22%) had ≥ 1 readmission within 30 days. From the 50 manually reviewed records, the most common diagnosis categories for either the index admission or the readmission were infection, pain, and gastrointestinal issues. For 64% of these patients, the diagnoses of the index admission and the readmission were different. Disagreement between the care team and patient/family about the index admission discharge plan was documented in 10%. The readmission was determined to be preventable in 1 (2%) of the 50 manually reviewed cases. CONCLUSIONS: Readmissions in this cancer population are common and reflect the refractory nature of these diseases and the high disease burdens. The vast majority of readmissions in this population, by our criteria, were not preventable. Our ongoing research in this vulnerable population includes efforts to better characterize and communicate care options, especially in the cases in which there was disagreement between the care team and patient/family.
Keywords: adult; aged; aged, 80 and over; middle aged; united states; time; time factors; gastrointestinal neoplasms; electronic medical record; hospital discharge; hospital readmission; patient discharge; socioeconomics; socioeconomic factors; gastrointestinal tumor; complication; electronic health records; patient readmission; very elderly; humans; human; male; female; statistics and numerical data
Journal Title: Hospital Practice
Volume: 42
Issue: 5
ISSN: 2154-8331
Publisher: Taylor & Francis Group  
Date Published: 2014-12-01
Start Page: 34
End Page: 44
Language: English
DOI: 10.3810/hp.2014.12.1168
PUBMED: 25485916
PROVIDER: scopus
Notes: Export Date: 2 April 2015 -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    155 Chou
  2. Steven C Martin
    9 Martin
  3. Leonard B Saltz
    592 Saltz
  4. Barbara Egan
    9 Egan
  5. Marinela Capanu
    209 Capanu
  6. Andrew Saul Epstein
    69 Epstein
  7. Cori Salvit
    5 Salvit
  8. Chhavi Kumar
    7 Kumar
  9. Douglas Koo
    10 Koo
  10. Tabitha Nicole Goring
    6 Goring