Post-hospitalization oncology workflow implementing LACE+ score to stratify and reduce readmissions at Lyndon B. Johnson safety-net hospital.
Authors: Pabon Cindy M. , Earles Terri , Jimenez-Abarca Jessica , Perez Marcela , Jackson Lymesia D. , Wong Janine , Park Anne K. , Lankford Anjali R. , Akula Vinita , Datar Saumil , Hopper Taylor A. , Alkhatib Yaser , Patel Tejal Amar 
Published: October 2023

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Background: Patients with cancer visit the emergency room (ER) and are hospitalized frequently. Contributing factors may include uncontrolled symptoms (cancer- or treatment-related), caregiver fatigue, concerns about the cancer, and difficulty accessing healthcare elsewhere. It is estimated that nearly 50% of ER and hospital visits by advanced cancer patients may be avoidable. This may represent unmet needs in oncology outpatient care and counseling. The LACE+ index is a validated clinical tool available within EPIC electronic medical record system to predict the risk of 30-day readmission. Here we used LACE+ score, common concerns and demographics observed among cancer patients readmitted to Lyndon B. Johnson Hospital (LBJ), a safety-net hospital in Texas, to determine potential contributors and implement interventions to reduce unplanned admissions. Methods: Retrospective data of ER visits and hospitalizations among cancer patients at LBJ were collected from 6/2022-12/2022. Data included comorbidities, cancer diagnosis and therapy, indication for visit, acuity on arrival, additional visits within 30 days, primary language, and LACE+ score. Descriptive statistics were used to guide intervention(s) to reduce hospital readmission. Specifically, these results led to the development of a triaging system based on LACE+ score to arrange timely post-hospital follow-up in the oncology clinic. Our findings also led to translation of AskMyNurse resources to Spanish. Results: Our group identified 61 oncology patients who had visited the ER or been hospitalized at LBJ from 6/2022-12/2022. From this cohort, 90% had been hospitalized or visited an ER within the past 30 days. LACE+ scores were consistently elevated within this group and visits were largely related to their cancer. Additionally, about 66% spoke primarily Spanish. Presently, oncology patients who are discharged from LBJ Hospital are having follow-up arranged in the clinic by means of risk stratification by their LACE+ score. Those with the highest score are seen the earliest after discharge. At this visit, in addition, AskMyNurse resources are now provided in Spanish. Collection of post-intervention data is ongoing to evaluate whether hospital readmission rates are effectively reduced. Conclusions: Cancer patients, especially those with language barriers and in the context of a safety-net hospital, are a particularly vulnerable group. The ability to triage and accurately identify patients at most risk of adverse post-hospitalization outcomes may help direct proper counseling, cancer treatment, and symptom management in the outpatient setting. Here our group proposes a feasible risk stratification tool using the LACE+ score on EPIC to allow for timely post-hospital follow-up and reduce 30-day hospital readmission.