Impact of supportive oncology (SO) visits on healthcare utilization.
Authors: Crowley Fionnuala , Sheng Tianxiang , Zeng Li , Hobensack Mollie , Bilani Nadeem , Sheppard Richard Stephen , Barley Kevin M. , Popp Beth , Afezolli Debora , Kelly Lauren , Chen Joanna , Austin Vanessa , Bajwa Aleena , Easton Eve , Pagala Arlyn , Kim Emily , Gelfman Laura P. , Smith Cardinale B. 
Published: September 2024

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Background:
Palliative care (PC) has demonstrated a reduction in acute care utilization for health systems. PC input for patients with cancer has been associated with fewer emergency room visits, hospitalizations and hospital deaths in the last 30 days of life. Less is known about the upstream effects of PC referral on healthcare utilization (HCU). We examined HCU among patients in the 90 days after first SO appointment and predictors of high HCU.
Methods:
Patients ≥18 years with first SO consult between 01/01/2021-06/30/2023 were included. Patients who died within 90 days of their first SO appointment and incomplete utilization data were censored. Data on patient demographics, acute healthcare and hospice utilization, cancer treatment and mortality was extracted from the electronic health record (EHR). Number of ED visits in 90 days before and after first SO visit were recorded. We used descriptive statistics to describe patients’ sociodemographics, clinical characteristics and healthcare utilization. High HCU was defined as patients in the top 10% of ED visits and IP stays. Logistic regression was employed to assess whether being a high utilizer is associated with baseline characteristics.
Results:
We included 859 patients. On average, there were approximately 0.12, 95%CI: [0.07,0.17] more ED visits in the 90 days before the first SO appointment compared to 90 days after. There was no difference in hospitalization rates before and after the first SO appointment. Overall, 45 patients met the criteria for high HCU. The median number of ED visits and hospitalizations of high utilizers was 6 visits, compared to 1 visit for remainder of the population. There was a significant association with ethnicity with those identified as Hispanic (60%) being high HCU. There was no significant association between age, insurance status, cancer type, primary language and high HCU. High utilizers were 189% more likely to die in hospital although this did not meet statistical significance (p= 0.242).
Conclusions:
The findings reveal significant variations in healthcare utilization, particularly among Hispanic patients, indicating a need for targeted interventions to address these disparities. Despite no observed changes in hospitalization rates, the study emphasizes the need for further research to understand the underlying factors contributing to high healthcare utilization. Future efforts should focus on developing tailored strategies to optimize PC referrals and enhance patient outcomes across diverse populations.

Race/ethnicity by utilization group.

Category
<90th Percentile Utilization (n=814) %
>90th Percentile Utilization (n=45) %
P value

Race (%)

<0.001

Asian
97 (11)
0 (0)

Black or African American
173 (21)
8 (18)

Hispanic
198 (24)
27 (60)

Other
50 (6)
3 (7)

White
296 (36)
7 (16)