Impact of cancer supportive care pathways compliance on emergency department visits and hospitalizations.
OBJECTIVE
To evaluate the effects of compliance to cancer supportive care pathways on emergency department (ED) visits and hospitalizations as a result of neutropenia, anemia, and chemotherapy-induced nausea and vomiting (CINV).


METHODS
CareFirst claims database was used to evaluate data spanning 2 years of the clinical pathways program. Frequency of ED visits/hospitalizations for neutropenia, anemia, and CINV were compared between compliant and noncompliant pathway utilization of granulocyte colony-stimulating factors (G-CSFs), erythropoiesis-stimulating agents (ESAs), and antiemetics, respectively. Logistic regression analysis was used to control for drug expenditures and cancer types.


RESULTS
A total of 4,144 lines of therapy were received by 3,191 patients from 46 practices across three states. Overall, there were 472 ED visits/hospitalizations for neutropenia, 34 visits for anemia, and 799 visits for CINV. G-CSF pathway-compliant treatment was associated with a significant reduction in neutropenia ED visits/hospitalizations compared with noncompliant treatment (odds ratio [OR] = 0.34; 95% CI, 0.25 to 0.45; P < .001). Adjusting for cancer type and G-CSF drug expenditures, a similar reduction in neutropenia ED visits/hospitalizations was observed (OR = 0.42; 95% CI 0.30 to 0.58; P < .001). Analogous analyses did not demonstrate a significant association between ESA and antiemetic pathway compliance and ED visits/hospitalizations for anemia (P = .069) and CINV (P = .106), respectively. G-CSF therapy pathway compliance was also associated with an average decrease of $1,085 in ED visit/hospitalization costs per line of therapy (P < .001).


CONCLUSIONS
G-CSF pathway compliance was associated with a significant decrease in the rate of neutropenia ED visits/hospitalizations and resulting costs.
University of Texas at Austin, Austin; and The University of Texas Health Science Center at San Antonio, San Antonio, TX kreys@uthscsa.edu.
Eugene D
ED
Kreys
University of Texas at Austin, Austin; and The University of Texas Health Science Center at San Antonio, San Antonio, TX.
Ted Y
TY
Kim
University of Texas at Austin, Austin; and The University of Texas Health Science Center at San Antonio, San Antonio, TX.
Andrew
A
Delgado
University of Texas at Austin, Austin; and The University of Texas Health Science Center at San Antonio, San Antonio, TX.
Jim M
JM
Koeller
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use; D006397:Hematinics / Q000191:economics / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D055118:Medication Adherence; D009503:Neutropenia / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control; D010166:Palliative Care; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D006397:Hematinics; D016179:Granulocyte Colony-Stimulating Factor