ABSTRACT
INTRODUCTION: Studies suggest that many emergency department (ED) visits and hospitalizations for patients with cancer may be preventable. The Centers for Medicare & Medicaid Services has implemented changes to the hospital outpatient reporting program that targets acute care in-treatment patients for preventable conditions. Oncology urgent care centers aim to streamline patient care. Our cancer center developed an urgent care center called the direct referral unit in 2011. METHODS: We abstracted visits to our adjacent hospital ED and direct referral unit from January 2014 to June 2018. Patient demographics, cancer and visit diagnoses, visit charges, and 30-day therapy utilization were assessed. RESULTS: An analysis of 13â114 visits demonstrated that increased direct referral unit utilization was associated with decreased monthly ED visits (P < .001). Common direct referral unit visit diagnoses were dehydration, nausea and vomiting, abdominal pain, and fever. Patients receiving active cancer treatment more frequently presented to the direct referral unit (P < .001). The average charges were $2221 for the direct referral unit and $10â261 for the ED. CONCLUSION: The association of decreased ED visits with increased direct referral unit utilization demonstrates the potential for urgent care centers to reduce acute care visits. Many patients presented to our direct referral unit with preventable conditions, and these visits were associated with considerable cost savings, supporting its use as a cost-effective method to reduce acute care costs.
Subject(s)
Emergency Service, Hospital , Neoplasms , Humans , Aged , United States , Medicare , Patient Acceptance of Health Care , Ambulatory Care Facilities , Costs and Cost Analysis , Neoplasms/epidemiology , Neoplasms/therapyABSTRACT
Se realizó un estudio prospectivo aleatorio y simple ciego con el prospósito de comparar la solución de Fosfato Sódico con Polietilenglicol en términos de cumplimiento, tolerabilidad y calidad de preparación del colon para endoscopia. Para ello se incluyeron 99 pacientes con indicación de colonoscopia electiva, de los cuales 48 recibieron Polietilenglicol (PEG) y 51 Fosfato Sódico. El cumplimiento de la preparación fue considerado más fácil por los pacientes que recibieron Fosfato Sódico, no existiendo diferencia estadística. 82.2 por ciento del grupo Fosfato Sódico la consideró buena o tolerable al evaluar gusto frente al 43,7 por ciento del grupo PEG existiendo una diferencia estadísticamente significante (p=0,00007). No hubo diferencia estadística con respecto a efectos colaterales. La calidad de la preparación fue similar para ambos grupos. Concluimos que la solución de Fosfato Sódico resultó superior al PEG en términos de tolerabilidad y aceptación por parte del paciente, por lo cual debe ser considerada una alternativa en la preparación anterógrada del colon