title: Use of ED and hospital services for patients with acute leukemia after induction therapy: one year follow-up.
abstract: Previous studies have documented use of health care services by oncology patients in the Emergency Department (ED), but little is known about the utilization of health services of patients with acute leukemia after induction therapy. The aim of this study was to examine chief reasons for ED and hospital use by patients newly diagnosed with acute leukemia patients after induction therapy up to one year after discharge. A retrospective, longitudinal study of all visits to the ED or unplanned hospital admissions at a single institution for patients with acute leukemia was conducted. Inclusion criteria were patients ≥18 years of age at time of diagnosis, a confirmed diagnosis of AML or ALL, and received and discharged from induction treatment between 2007 and 2010. Donabedian's structure-process-outcome framework guided this study examining health services utilization and assessing patient outcomes. 80 patients met the inclusion criteria; 52 had AML and 28 had ALL; median age was 48 (range: 18-76) and 29% (n=23) were non-Caucasian. 70% (n=56) were discharged from induction in remission. 81% (n=65) had at least 1 ED or hospitalization event, and 44% (n=35) had 2 or more events. Of 137 events in 65 patients, the most common reason was neutropenic fever/infection (55%), bleeding (12%), and GI problems (11%). Mean number of events for ALL was 2.43 compared to 1.33 for AML patients (p=0.02), and 2.23 for <50 years of age compared to 1.20 for those older (p=0.002). 20 patients died within one year of diagnosis. Findings from this study can help inform health services delivery and utilization among patients with acute leukemia after induction therapy. Oncology providers can anticipate discharge needs and enhance follow-up care for those at higher risk for problems needing hospitalization.
authors.affiliation: School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. Electronic address: anleak@email.unc.edu.
authors.forename: Ashley Leak
authors.initials: AL
authors.lastname: Bryant
authors.affiliation: Lineberger Comprehensive Cancer Center Biostatistics Core, The University of North Carolina at Chapel Hill, United States. Electronic address: Allison_Deal@med.unc.edu.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.affiliation: School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center Biostatistics Core, The University of North Carolina at Chapel Hill, United States; University of Utah College of Nursing, United States. Electronic address: annmarie.walton@utah.edu.
authors.forename: AnnMarie
authors.initials: A
authors.lastname: Walton
authors.affiliation: Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, United States. Electronic address: wawood@med.unc.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.affiliation: Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, United States. Electronic address: Hyman_muss@med.unc.edu.
authors.forename: Hyman
authors.initials: H
authors.lastname: Muss
authors.affiliation: School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. Electronic address: dmayer@unc.edu.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000209:etiology; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000175:diagnosis / Q000209:etiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Acute leukemia; Emergency Department; Health care utilization; Hospitalization; Induction therapy