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Analysis

Cancer Urgent Care Clinics Slow Growth of ER Utilization

By Christopher Cheney  
   July 01, 2019

A cancer urgent care clinic in Texas reduced growth of emergency department utilization by more than half.

Cancer urgent care clinics can reduce emergency department (ED) utilization, new research indicates.

In the first six months after a cancer diagnosis, adult patients generate a high volume of unplanned visits to emergency rooms for commonly expected complaints such as nausea and pain. After ED visits, many cancer patients are hospitalized, which exposes them hospitalization risks, disrupts treatment schedules, and increases cancer care expenditures.

The new research, which was published in the Journal of Oncology Practice, found cancer urgent care clinics are a promising strategy to lower cost of care, the researchers wrote.

"Given the outsized role of unplanned hospital care in the early expenditures of cancer treatment, this delivery innovation was highly effective and may be a promising strategy for organizations participating in the Oncology Care Model demonstration project and other risk-bearing contracts, such as accountable care organizations."

Impact of cancer urgent care clinic on emergency department visits
 

The researchers examined the ED-visit impact of a cancer urgent care clinic opened at Dallas-based University of Texas Southwestern Medical Center in May 2012. The cancer urgent care clinic is available to patients during standard weekday business hours—8 a.m. to 4 p.m.

The study features an analysis of data collected from more than 33,000 adult patients. The research generated a key finding: the cancer urgent care clinic was associated with significantly reduced growth of ED service utilization.

Before the cancer urgent care clinic was opened, weekday ED visits were increasing at a rate of 0.43 visits per 1,000 patient-months. After the clinic was opened, the growth of ED visits was cut by more than half to 0.19 visits per 1,000 patient-months.

On weekends, when the cancer urgent care center was closed, there was no significant change in ED utilization.

"More than four years after implementation, the creation of a cancer urgent care clinic was associated with a significant reduction in ED visits made within the 180 days after a new cancer diagnosis. In contrast, the rate of ED visits made on weekends, when the UCC was closed, remained unchanged over the same period of time. This increases our confidence that the urgent care clinic was associated with a real reduction in ED visits when the clinic was open," the researchers wrote.

Innovative cancer care strategy
 

Cancer urgent care clinics are a relatively new and innovative approach to cancer care worthy of more widespread adoption and research, the lead author of the new study told HealthLeaders.

"What patients really want is a trusted resource and an alternative to the emergency department because—anywhere you go in the country—there are untold hours you could wait at an ED. Patients also may be worried about being exposed to the dangerous infections that people have in an emergency department. An urgent care center checks off a lot of boxes in terms of what cancer patients are looking for," said Arthur Hong, MD, an assistant professor of internal medicine and clinical sciences at UT Southwestern.

Only a handful of healthcare organizations have reported adoption of cancer urgent care centers, including Parkland Hospital in Dallas and Yale New Haven Health in Connecticut, he said.

Hong said there are common cancer-related symptoms that can be treated safely in the urgent care setting, including pain, headache, nausea, vomiting, diarrhea, and constipation. The UT Southwestern cancer urgent care clinic offers services that address these symptoms such as administering intravenous fluids and medications, obtaining basic laboratory tests with rapid results, and conducting common imaging tests such as chest X-ray.

Before launching a cancer urgent care clinic, healthcare organizations should assess their cancer patient population to determine which services would be most be most effective and useful for patients in an urgent care setting, he said. "Each institution has the ability to look at its line of business and find the common reasons patients would use a cancer urgent care clinic."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

For cancer patients, emergency department visits are associated with high hospitalization rates, disrupted treatment schedules, and high costs of care.

Oncology patients can be treated safely in the urgent care setting for several cancer-related symptoms such as nausea and pain.

Healthcare organizations considering adoption of cancer urgent care clinics should assess their oncology patient population to determine which services would be most be most effective and useful for patients in an urgent care setting.


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