title: Factors Associated With Unplanned Hospitalizations Among Patients With Nonmetastatic Colorectal Cancers Intended for Treatment in the Ambulatory Setting.
abstract: BACKGROUND
  Chemotherapy administration and supportive management for solid tumors is intended to take place in the ambulatory setting, but little is known about why some patients experience treatment-related adverse events so severe as to require acute inpatient care.
  
  
  OBJECTIVE
  The aim of the study was to identify predictors of initial and repeated unplanned hospitalizations and potential financial impact among Medicare patients with early-stage (Stages I-III) colorectal cancer receiving outpatient chemotherapy.
  
  
  METHODS
  Advanced statistical modeling was used to analyze a cohort of patients (N = 1,485) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed from 2003 to 2007 with colorectal cancer as their first primary malignancy. Patients were of ages 66 and older at diagnosis, had uninterrupted Medicare Parts A and B coverage with no health maintenance organization component, and received chemotherapy at least one time.
  
  
  RESULTS
  Female gender, younger age, multiple comorbidities, rural geography, higher high school completion rates, and lower median income per census tract were significant predictors of the likelihood of initial unplanned hospitalizations. Non-White race, receipt of radiation therapy, rural geography, and higher weighted comorbidity scores were factors associated with the number of hospitalizations experienced. The total Medicare charges calculated for these admissions was $38,976,171, with the median charge per admission at $20,412.
  
  
  CONCLUSIONS
  Demographic and clinical factors that form the foundation of work toward development of a risk factor profile for unplanned hospitalization were identified. Further work is needed to incorporate additional clinical data to create a clinically applicable model.
authors.affiliation: Kristen L. Fessele, PhD, RN, AOCN, is Postdoctoral Fellow, University of Utah College of Nursing, Salt Lake City. Matthew J. Hayat, PhD, is Associate Professor, School of Public Health, Georgia State University, Atlanta. Deborah K. Mayer, PhD, RN, AOCN, FAAN, is Professor, School of Nursing, and Director of Cancer Survivorship, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Robert L. Atkins, PhD, RN, FAAN, is Associate Professor of Childhood Studies and Nursing and Director, New Jersey Health Initiatives-Robert Wood Johnson Foundation, Rutgers, The State University of New Jersey, New Brunswick.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Fessele
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hayat
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.forename: Robert L
authors.initials: RL
authors.lastname: Atkins
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D044469:Racial Groups; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D012424:Rural Population; D018426:SEER Program; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents