使用新定义识别潜在可预防的急诊就诊高风险肿瘤患者。

IF 3.3 Q2 ONCOLOGY JCO Clinical Cancer Informatics Pub Date : 2024-11-01 Epub Date: 2024-10-30 DOI:10.1200/CCI-24-00147
Lauren Fleshner, Sonal Gandhi, Andrew Lagree, Louise Boulard, Robert C Grant, Alex Kiss, Monika K Krzyzanowska, Ivy Cheng, William T Tran
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引用次数: 0

摘要

目的:癌症患者经常到急诊科(ED)就诊。虽然有些急诊就诊是必要的,但有些可能是潜在的可预防急诊就诊(PPED)。减少 PPED 对提高医疗质量和降低成本非常重要。然而,关于高危患者的确切定义和特征仍不清楚。本研究旨在描述与肿瘤相关的 PPEDs,并确定 PPEDs 高危患者的特征,以帮助有针对性地采取干预措施,尽量减少可避免的急诊就诊:方法:利用四个临床和行政数据库开展了一项回顾性研究。方法:利用四个临床和行政数据库开展了一项回顾性研究,确定了肿瘤患者在 2019 年 4 月 1 日至 2021 年 4 月 1 日期间就诊的所有急诊室。研究探索了 PPED 的新定义,特别是导致急诊室立即出院或入院的就诊结果:在这两年期间,共有 6689 名肿瘤患者就诊于急诊室(N = 13415 人次)。共有 62.1% 的就诊被归类为 PPED。PPED在I期至III期乳腺癌患者和接受系统治疗的患者中最为常见。非PPED高危患者的特征包括肺癌或消化道癌IV期患者以及距离急诊室较短的患者。表现最好的 ML 模型的 AUC 为 0.819:我们对 PPEDs 的新定义在识别肿瘤患者方面似乎很有希望,这些患者可以通过有针对性的干预措施避免急诊室就诊。这项工作表明,早期疾病患者、乳腺癌患者和接受系统治疗的患者发生 PPEDs 的风险最高,可能会从避免急诊室的主动干预中获益。尽管我们的定义还需要验证,但使用 ML 模型建立更强大的预测模型似乎大有可为。
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Identifying Oncology Patients at High Risk for Potentially Preventable Emergency Department Visits Using a Novel Definition.

Purpose: Patients with cancer visit the emergency department (ED) frequently. While some ED visits are necessary, others may be potentially preventable ED visits (PPEDs). Reducing PPEDs is important to improve quality of care and reduce costs. However, a robust definition and the characteristics of patients at risk remain unclear. This study aimed to describe oncology-related PPEDs and identify characteristics of patients at the highest risk for PPEDs to help target interventions and minimize avoidable ED visits.

Methods: A retrospective study was conducted using four clinical and administrative databases. All ED visits by oncology patients between April 1, 2019, and April 1, 2021, were identified. A novel definition of PPEDs was explored, specifically visits that resulted in immediate discharge from the ED or admissions <48 hours. Trends in ED use, including PPEDs, were evaluated using descriptive statistics, logistic regression, and machine learning (ML) modeling.

Results: During the 2-year period, 6,689 oncology patients visited the ED (N = 13,415 visits). A total of 62.1% of visits were classified as PPEDs. PPEDs were most common among patients with stage I to III breast cancer and those on systemic therapy. Characteristics of patients at high risk for non-PPEDs included stage IV disease with either lung or GI carcinomas and shorter distances to the ED. The highest-performing ML model yielded an AUC of 0.819.

Conclusion: Our novel definition of PPEDs appears promising in identifying oncology patients who could avoid the ED with targeted interventions. This work demonstrated that patients with early-stage disease, those with breast cancer, and those on systemic therapy are at the highest risk for PPEDs and may benefit from proactive interventions to avoid the ED. Although our definition requires validation, using ML models for more robust predictive modeling appears promising.

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CiteScore
6.20
自引率
4.80%
发文量
190
期刊最新文献
Identifying Oncology Patients at High Risk for Potentially Preventable Emergency Department Visits Using a Novel Definition. Use of Patient-Reported Outcomes in Risk Prediction Model Development to Support Cancer Care Delivery: A Scoping Review. Optimizing End Points for Phase III Cancer Trials. Patients Facing Large Language Models in Oncology: A Narrative Review. Informatics and Artificial Intelligence-Guided Assessment of the Regulatory and Translational Research Landscape of First-in-Class Oncology Drugs in the United States, 2018-2022.
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