title: Identification of potentially avoidable hospitalizations in patients with GI cancer.
abstract: OBJECTIVE
  To identify and characterize potentially avoidable hospitalizations in patients with GI malignancies.
  
  
  METHODS
  We compiled a retrospective series of sequential hospital admissions in patients with GI cancer. Patients were admitted to an inpatient medical oncology or palliative care service between December 2011 and July 2012. Practicing oncology clinicians used a consensus-driven medical record review process to categorize each hospitalization as "potentially avoidable" or "not avoidable." Patient demographic and clinical data were abstracted, and quantitative and qualitative analyses were performed to identify patient characteristics and outcomes associated with potentially avoidable hospitalizations.
  
  
  RESULTS
  We evaluated 201 hospitalizations in 154 unique patients. The median age was 62 years, and colorectal cancer was the most common diagnosis (32%). The majority of hospitalized patients had metastatic cancer (81%). In all, 53% of hospitalizations were attributable to cancer symptoms, and 28% were attributable to complications of cancer treatment. Medical oncologists identified 39 hospitalizations (19%) as potentially avoidable. Hospitalizations were more likely to be categorized as potentially avoidable for patients with the following characteristics: age ≥ 70 years (odds ratio [OR], 2.63; 95% CI, 1.15 to 6.02), receipt of an oncologist's advice to consider hospice (OR, 6.09; 95% CI, 2.54 to 14.58), or receipt of three or more lines of chemotherapy (OR, 2.68; 95% CI, 1.01 to 7.08). Ninety-day mortality was higher after avoidable hospitalizations compared with hospitalizations that were not avoidable (OR, 6.4; 95% CI, 1.8 to 22.3).
  
  
  CONCLUSIONS
  Potentially avoidable hospitalizations are common in patients with advanced GI cancer. The majority of potentially avoidable hospitalizations occurred in patients with advanced treatment-refractory cancers near the end of life.
authors.affiliation: All authors: Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Brooks
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Abrams
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Meyerhardt
authors.forename: Peter C
authors.initials: PC
authors.lastname: Enzinger
authors.forename: Karen
authors.initials: K
authors.lastname: Sommer
authors.forename: Carole K
authors.initials: CK
authors.lastname: Dalby
authors.forename: Hajime
authors.initials: H
authors.lastname: Uno
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Jacobson
authors.forename: Charles S
authors.initials: CS
authors.lastname: Fuchs
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D055815:Young Adult