Potentially avoidable hospitalizations after chemotherapy: Differences across medicare and the Veterans Health Administration

Background The Centers for Medicare and Medicaid Services (CMS) has released quality measures regarding potentially avoidable hospitalizations visits in the 30 days after receipt of outpatient chemotherapy. This study evaluated the proportions of patients treated by Medicare‐reimbursed clinicians an...

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Bibliographic Details
Published in:Cancer 2020-07, Vol.126 (14), p.3297-3302
Main Authors: Gidwani‐Marszowski, Risha, Faricy‐Anderson, Katherine, Asch, Steven M., Illarmo, Samantha, Ananth, Lakshmi, Patel, Manali I.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Ambulatory Care - methods
Anemia
Cancer
Centers for Medicare and Medicaid Services, U.S
Chemotherapy
Confidence intervals
Dehydration
Diarrhea
Fever
Government programs
Hospitalization
Hospitals, Veterans
Humans
Male
Medicare
Nausea
Neoplasms - drug therapy
Neutropenia
Oncology
Pain
Patient Admission
Performance evaluation
Private sector
Quality of Health Care
Retrospective Studies
Sepsis
Terminology
Treatment Outcome
United States
Veterans
Veterans Health
Veterans Health Services
Vomiting
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Summary:Background The Centers for Medicare and Medicaid Services (CMS) has released quality measures regarding potentially avoidable hospitalizations visits in the 30 days after receipt of outpatient chemotherapy. This study evaluated the proportions of patients treated by Medicare‐reimbursed clinicians and Veterans Health Administration (VA) clinicians who experienced avoidable acute care in order to evaluate differences in health system performance. Methods This retrospective evaluation of Medicare and VA administrative data used a cohort of cancer decedents (fiscal years 2010‐2014). Cohort members were veterans aged 66 years or older at death who were dually enrolled in Medicare and the VA. Chemotherapy was identified through International Classification of Diseases, Ninth Revision and Current Procedural Terminology (ICD-9) codes. CMS defines avoidable hospitalizations as those related to anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis in the 30 days after chemotherapy. Following CMS guidance, this study compared the proportions of patients with potentially avoidable hospitalizations, using hierarchical generalized estimating equations. Results There were 27,443 patients who received outpatient chemotherapy. Patients receiving Medicare chemotherapy were significantly more likely to have potentially avoidable hospitalizations than patients receiving VA chemotherapy (adjusted odds ratio, 1.58; 95% confidence interval, 1.41‐1.78; P 
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.32896