Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration

被引:7
作者
Gidwani-Marszowski, Risha [1 ,2 ,3 ]
Faricy-Anderson, Katherine [4 ,5 ]
Asch, Steven M. [2 ,6 ]
Illarmo, Samantha [1 ]
Ananth, Lakshmi [1 ]
Patel, Manali, I [7 ,8 ]
机构
[1] VA Palo Alto Hlth Care Syst, Hlth Econ Resource Ctr, 795 Willow Rd, Menlo Pk, CA 94025 USA
[2] VA Palo Alto Hlth Care Syst, Ctr Innovat Implementat, Menlo Pk, CA USA
[3] UCLA, Sch Publ Hlth, Dept Hlth Management & Policy, Los Angeles, CA 90024 USA
[4] Providence VA Med Ctr, Providence, RI USA
[5] Brown Univ, Alpert Med Sch, Providence, RI 02912 USA
[6] Stanford Univ, Div Primary Care & Populat Hlth, Sch Med, Stanford, CA 94305 USA
[7] VA Palo Alto Hlth Care Syst, Palo Alto, CA USA
[8] Stanford Univ, Div Oncol, Sch Med, Stanford, CA 94305 USA
关键词
Medicare; quality of health care; veterans; METASTATIC BREAST-CANCER; ADVERSE EVENTS; OLDER-ADULTS; CARE; RISK; SYSTEM; TOXICITY; TRENDS;
D O I
10.1002/cncr.32896
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background The Centers for Medicare and Medicaid Services (CMS) has released quality measures regarding potentially avoidable hospitalizations visits in the 30 days after receipt of outpatient chemotherapy. This study evaluated the proportions of patients treated by Medicare-reimbursed clinicians and Veterans Health Administration (VA) clinicians who experienced avoidable acute care in order to evaluate differences in health system performance. Methods This retrospective evaluation of Medicare and VA administrative data used a cohort of cancer decedents (fiscal years 2010-2014). Cohort members were veterans aged 66 years or older at death who were dually enrolled in Medicare and the VA. Chemotherapy was identified through International Classification of Diseases, Ninth Revision and Current Procedural Terminology (ICD-9) codes. CMS defines avoidable hospitalizations as those related to anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis in the 30 days after chemotherapy. Following CMS guidance, this study compared the proportions of patients with potentially avoidable hospitalizations, using hierarchical generalized estimating equations. Results There were 27,443 patients who received outpatient chemotherapy. Patients receiving Medicare chemotherapy were significantly more likely to have potentially avoidable hospitalizations than patients receiving VA chemotherapy (adjusted odds ratio, 1.58; 95% confidence interval, 1.41-1.78; P < .001). In predicted estimates, 7.1% of Medicare-treated veterans had potentially avoidable hospitalizations in the 30 days after chemotherapy, compared with 4.6% of VA-treated veterans. Conclusions Results indicate veterans with cancer receiving chemotherapy in the VA have higher quality care with respect to avoidable hospitalizations than veterans receiving chemotherapy through Medicare. As more veterans seek care in the private sector under the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, concerted efforts may be warranted to ensure that veterans do not experience a decline in care quality.
引用
收藏
页码:3297 / 3302
页数:6
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