title: Health care utilization among surgically treated Medicare beneficiaries with lung cancer.
abstract: BACKGROUND
  Markers of increased health care utilization are surrogates for adverse events, and one such metric--prolonged length of stay greater than 14 days (PLOS)--was recently endorsed as a provider-level performance measure.
  
  
  METHODS
  This is a cohort study (1992 through 2002) aimed to describe increased health care utilization among 21,067 operated lung cancer patients using the Surveillance, Epidemiology, and End-Results-Medicare database. Increased utilization was defined by PLOS, discharge to an institutional care facility (ICF), or readmission within 30 days.
  
  
  RESULTS
  Twelve percent of patients had a PLOS, 13% were discharged to an ICF, and 15% were readmitted. In multivariate analyses, factors associated with a higher odds ratio of PLOS, discharge to ICF, or readmission included age older than 80 years, increasing comorbidity index, not being married, and pneumonectomy (all p < 0.05). Relative to patients living in the West, those in the Midwest or South had a higher odds ratio of PLOS and readmission but a lower odds ratio of discharge to an ICF (all p < 0.05). Adjusted rates of PLOS decreased significantly with time, whereas adjusted ICF and readmission rates increased (all p < 0.01). Patients who required increased utilization had higher adjusted 2.5-year mortality rates compared with those who did not (PLOS, 42% versus 20%; ICF, 32% versus 20%; readmission, 33% versus 19%; all p < 0.001).
  
  
  CONCLUSIONS
  Baseline health status and nonclinical factors were associated with increased utilization, nonuniform trends in utilization were observed with time, and increased utilization was associated with worse long-term outcomes. These findings have implications for quality-improvement initiatives that measure increased health care utilization as a surrogate for provider performance.
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington 98195-6410, USA.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Varghese
authors.forename: Nader N
authors.initials: NN
authors.lastname: Massarweh
authors.forename: Rebecca Gaston
authors.initials: RG
authors.lastname: Symons
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000601:surgery; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D011013:Pneumonectomy / Q000191:economics*; D012189:Retrospective Studies; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States