Prospective cohort study of hospitalized adults with advanced cancer

Associations between complications, comorbidity, and utilization

Peter May, Melissa M. Garrido, Melissa D. Aldridge, J. Brian Cassel, Amy S. Kelley, Diane E. Meier, Charles Normand, Joan D. Penrod, Thomas J Smith, R. Sean Morrison

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers. PATIENTS: Adults with advanced cancer admitted to a participating hospital between 2007 and 2011, excluding those with dementia. Final analytic sample included 1020 patients. METHODS: With receipt of palliative care controlled for, the associations between hospital cost and patient factors were estimated. Factors covered the domains of demographics (age, sex, race), socioeconomics and systems (education, insurance, living will, proxy), clinical care (diagnoses, complications deemed to pose a threat to life or bodily functions, comorbidities, symptom burden, activities of daily living), and prior healthcare utilization (home help, analgesic prescribing). OUTCOME MEASURE: Direct hospital costs. RESULTS: A major (markedly abnormal) complication (+$8267; P < 0.01), a minor but not a major complication (+$5289; P < 0.01), and number of comorbidities (+$852; P < 0.01) were associated with higher cost, and admitting diagnosis of electrolyte disorders (–$4759; P = 0.01) and increased age (–$53; P = 0.03) were associated with lower cost. CONCLUSIONS: Complications and comorbidity burden drive inhospital utilization for adults with advanced cancer. There is little evidence of sociodemographic associations and no apparent impact of advance directives. Attempts to control growth of hospital cancer costs require consideration of how the most resource-intensive patients are identified promptly and prioritized for cost-effective care.

Original languageEnglish (US)
Pages (from-to)407-413
Number of pages7
JournalJournal of Hospital Medicine
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2017

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Hospital Costs
Comorbidity
Cohort Studies
Prospective Studies
Costs and Cost Analysis
Neoplasms
Demography
Living Wills
Advance Directives
Proxy
Activities of Daily Living
Insurance
Palliative Care
Health Care Costs
Electrolytes
Analgesics
Dementia
Inpatients
Length of Stay
Delivery of Health Care

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

May, P., Garrido, M. M., Aldridge, M. D., Cassel, J. B., Kelley, A. S., Meier, D. E., ... Morrison, R. S. (2017). Prospective cohort study of hospitalized adults with advanced cancer: Associations between complications, comorbidity, and utilization. Journal of Hospital Medicine, 12(6), 407-413. https://doi.org/10.12788/jhm.2745

Prospective cohort study of hospitalized adults with advanced cancer : Associations between complications, comorbidity, and utilization. / May, Peter; Garrido, Melissa M.; Aldridge, Melissa D.; Cassel, J. Brian; Kelley, Amy S.; Meier, Diane E.; Normand, Charles; Penrod, Joan D.; Smith, Thomas J; Morrison, R. Sean.

In: Journal of Hospital Medicine, Vol. 12, No. 6, 01.06.2017, p. 407-413.

Research output: Contribution to journalArticle

May, P, Garrido, MM, Aldridge, MD, Cassel, JB, Kelley, AS, Meier, DE, Normand, C, Penrod, JD, Smith, TJ & Morrison, RS 2017, 'Prospective cohort study of hospitalized adults with advanced cancer: Associations between complications, comorbidity, and utilization', Journal of Hospital Medicine, vol. 12, no. 6, pp. 407-413. https://doi.org/10.12788/jhm.2745
May, Peter ; Garrido, Melissa M. ; Aldridge, Melissa D. ; Cassel, J. Brian ; Kelley, Amy S. ; Meier, Diane E. ; Normand, Charles ; Penrod, Joan D. ; Smith, Thomas J ; Morrison, R. Sean. / Prospective cohort study of hospitalized adults with advanced cancer : Associations between complications, comorbidity, and utilization. In: Journal of Hospital Medicine. 2017 ; Vol. 12, No. 6. pp. 407-413.
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abstract = "BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers. PATIENTS: Adults with advanced cancer admitted to a participating hospital between 2007 and 2011, excluding those with dementia. Final analytic sample included 1020 patients. METHODS: With receipt of palliative care controlled for, the associations between hospital cost and patient factors were estimated. Factors covered the domains of demographics (age, sex, race), socioeconomics and systems (education, insurance, living will, proxy), clinical care (diagnoses, complications deemed to pose a threat to life or bodily functions, comorbidities, symptom burden, activities of daily living), and prior healthcare utilization (home help, analgesic prescribing). OUTCOME MEASURE: Direct hospital costs. RESULTS: A major (markedly abnormal) complication (+$8267; P < 0.01), a minor but not a major complication (+$5289; P < 0.01), and number of comorbidities (+$852; P < 0.01) were associated with higher cost, and admitting diagnosis of electrolyte disorders (–$4759; P = 0.01) and increased age (–$53; P = 0.03) were associated with lower cost. CONCLUSIONS: Complications and comorbidity burden drive inhospital utilization for adults with advanced cancer. There is little evidence of sociodemographic associations and no apparent impact of advance directives. Attempts to control growth of hospital cancer costs require consideration of how the most resource-intensive patients are identified promptly and prioritized for cost-effective care.",
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AU - Cassel, J. Brian

AU - Kelley, Amy S.

AU - Meier, Diane E.

AU - Normand, Charles

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AU - Morrison, R. Sean

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N2 - BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers. PATIENTS: Adults with advanced cancer admitted to a participating hospital between 2007 and 2011, excluding those with dementia. Final analytic sample included 1020 patients. METHODS: With receipt of palliative care controlled for, the associations between hospital cost and patient factors were estimated. Factors covered the domains of demographics (age, sex, race), socioeconomics and systems (education, insurance, living will, proxy), clinical care (diagnoses, complications deemed to pose a threat to life or bodily functions, comorbidities, symptom burden, activities of daily living), and prior healthcare utilization (home help, analgesic prescribing). OUTCOME MEASURE: Direct hospital costs. RESULTS: A major (markedly abnormal) complication (+$8267; P < 0.01), a minor but not a major complication (+$5289; P < 0.01), and number of comorbidities (+$852; P < 0.01) were associated with higher cost, and admitting diagnosis of electrolyte disorders (–$4759; P = 0.01) and increased age (–$53; P = 0.03) were associated with lower cost. CONCLUSIONS: Complications and comorbidity burden drive inhospital utilization for adults with advanced cancer. There is little evidence of sociodemographic associations and no apparent impact of advance directives. Attempts to control growth of hospital cancer costs require consideration of how the most resource-intensive patients are identified promptly and prioritized for cost-effective care.

AB - BACKGROUND: Inpatient hospital stays account for more than a third of direct medical cancer care costs. Evidence on factors driving these costs can inform planning of services, as well as consideration of equity in access. OBJECTIVE: To measure the association between hospital costs, and demographic, clinical, and system factors, for a cohort of adults with advanced cancer. DESIGN: Prospective multisite cohort study. SETTING: Four medical and cancer centers. PATIENTS: Adults with advanced cancer admitted to a participating hospital between 2007 and 2011, excluding those with dementia. Final analytic sample included 1020 patients. METHODS: With receipt of palliative care controlled for, the associations between hospital cost and patient factors were estimated. Factors covered the domains of demographics (age, sex, race), socioeconomics and systems (education, insurance, living will, proxy), clinical care (diagnoses, complications deemed to pose a threat to life or bodily functions, comorbidities, symptom burden, activities of daily living), and prior healthcare utilization (home help, analgesic prescribing). OUTCOME MEASURE: Direct hospital costs. RESULTS: A major (markedly abnormal) complication (+$8267; P < 0.01), a minor but not a major complication (+$5289; P < 0.01), and number of comorbidities (+$852; P < 0.01) were associated with higher cost, and admitting diagnosis of electrolyte disorders (–$4759; P = 0.01) and increased age (–$53; P = 0.03) were associated with lower cost. CONCLUSIONS: Complications and comorbidity burden drive inhospital utilization for adults with advanced cancer. There is little evidence of sociodemographic associations and no apparent impact of advance directives. Attempts to control growth of hospital cancer costs require consideration of how the most resource-intensive patients are identified promptly and prioritized for cost-effective care.

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