Objectives: Concern for the cost of medical care has increased dramatically over the past several years. Among the many methods of controlling cost, decreasing the duration of hospitalization has met with some early success. There is now concern that rather than being eliminated, costs have been shifted from the hospital to the Emergency Center (EC). The main purpose of this study is to describe the magnitude of the problem and develop a method of identify patients at risk of early unscheduled visits to the EC.
Specific Aims : (1) To describe the incidence rate of episodes of early unscheduled visits to the EC in cancer patients recently discharged from the hospital; (2) To describe whether this rate has increased over time; (3) To identify surgical patients at increased risk for episodes of early unscheduled visits presenting to the EC; (4) To describe the costs (total and incremental) for patients with early unscheduled visits to the EC and for those with no such visits to the EC. Research Design and Methods: This study will be conducted in two phases: Phase I, a retrospective cohort study and Phase II, a case- control study of surgical cancer patients and a descriptive cost study. Phase I will use data available electronically from the institutional databases. It will describe the incidence of early unscheduled visits to the EC and will identify the factors routinely coded for all patients that predispose these patients to early unscheduled visits to the EC. For Phase II, cases and controls will be selected from the cohort population stratified by major cancer diagnoses. Data on additional factors will be collected from the medial record. By combining the unique risk factors from Phases I and II, we will develop a predictive model for surgical cancer patients at increased risk for early unscheduled visits to the EC. We will conduct a descriptive cost study with patients who have early unscheduled EC visits and patients with no such EC visits. Significance: The results of this study will change the practice of cancer care and provide substantial savings for institutions and patients.
