title: 30-day-or-sooner readmissions of gastrointestinal medical oncology patients following cancer center inpatient service discharge: characteristics and preventability.
abstract: OBJECTIVE
  The Centers for Medicare and Medicaid Services recently initiated readmission reduction programs for certain noncancer index admissions. Intrinsic to this policy is the assumption that such readmissions are reasonably preventable and are due to inadequate management. For cancer patients, readmission frequency, characteristics, and their preventability have not been extensively evaluated.
  
  
  METHODS
  We first electronically searched medical records of patients on our gastrointestinal oncology inpatient service to identify patients who had been discharged and then readmitted within 30 days. However, electronic review resulted in insufficient granularity of clinical records. Therefore, 50 of them were randomly selected for exhaustive manual review to assess the reasons for index admission and readmission, the nature of the index admission discharge plan, and whether the readmission was reasonably preventable or not, based on prespecified criteria.
  
  
  RESULTS
  Between September 1, 2008, and March 1, 2013, 3995 gastrointestinal medical oncology patients had an index admission, of whom 876 (22%) had ≥ 1 readmission within 30 days. From the 50 manually reviewed records, the most common diagnosis categories for either the index admission or the readmission were infection, pain, and gastrointestinal issues. For 64% of these patients, the diagnoses of the index admission and the readmission were different. Disagreement between the care team and patient/family about the index admission discharge plan was documented in 10%. The readmission was determined to be preventable in 1 (2%) of the 50 manually reviewed cases.
  
  
  CONCLUSIONS
  Readmissions in this cancer population are common and reflect the refractory nature of these diseases and the high disease burdens. The vast majority of readmissions in this population, by our criteria, were not preventable. Our ongoing research in this vulnerable population includes efforts to better characterize and communicate care options, especially in the cases in which there was disagreement between the care team and patient/family.
authors.affiliation: Department of Medicine, Gastrointestinal Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY. epsteina@mskcc.org.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Epstein
authors.forename: Christopher
authors.initials: C
authors.lastname: Crosbie
authors.forename: Steven C
authors.initials: SC
authors.lastname: Martin
authors.forename: Barbara
authors.initials: B
authors.lastname: Egan
authors.forename: Tabitha N
authors.initials: TN
authors.lastname: Goring
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Koo
authors.forename: Chhavi B
authors.initials: CB
authors.lastname: Kumar
authors.forename: Cori
authors.initials: C
authors.lastname: Salvit
authors.forename: Marinela
authors.initials: M
authors.lastname: Capanu
authors.forename: Joanna
authors.initials: J
authors.lastname: Chou
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Saltz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States