Dataset Information

Outcomes after emergency department use in patients with cancer receiving chemotherapy in Ontario, Canada: a population-based cohort study.

ABSTRACT:

Background

Patients with cancer frequently require emergency medical care during treatment. The objective of this study was to characterize emergency department visits made by patients with cancer receiving chemotherapy and to describe associated outcomes.

Methods

This retrospective cohort study used population-based administrative data from Ontario, Canada. Patients aged 18 years and older, with a cancer diagnosis, and who received chemotherapy in the 30 days before being seen in an emergency department between 2013 and 2017 were included. Emergency department discharge diagnosis codes were categorized to identify the most frequent emergency department diagnoses. We examined the proportion of patients admitted to hospital and 30-day mortality. We used logistic regression to identify predictors of hospital admission.

Results

We identified 218 459 emergency department visits made by 87 555 patients. The median number of emergency department visits per patient was 2 (interquartile range 1-3). Hematological, gastrointestinal, breast and lung cancer were the most common malignancies represented. The most common emergency department diagnoses were infection or fever (57 036 [26.1%]) and gastrointestinal diagnoses (26 456 [12.2%]). Of all visits, 77 978 (35.7%) resulted in admission to hospital. Thirty-day mortality after an emergency department visit was 9.8%. There was an increased odds of admission among patients who previously received palliative consultation, patients with bone or soft tissue or hematological malignancies, and patients with infection, gastrointestinal, pulmonary, cardiac, weakness or genitourinary and nephrology diagnoses.

Interpretation

Patients with cancer frequently used the emergency department during chemotherapy, and 1 in 4 emergency department visits were for infection or fever. These results highlight opportunities to optimize care for certain patients being actively treated for cancer, particularly around infectious complaints.

SUBMITTER: Grewal K

PROVIDER: S-EPMC7850167 | biostudies-literature | 2020 Jul-Sep

REPOSITORIES: biostudies-literature

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Publications

Outcomes after emergency department use in patients with cancer receiving chemotherapy in Ontario, Canada: a population-based cohort study.

Grewal Keerat K Krzyzanowska Monika K MK McLeod Shelley S Borgundvaag Bjug B Atzema Clare L CL

CMAJ open 20200701 3

<h4>Background</h4>Patients with cancer frequently require emergency medical care during treatment. The objective of this study was to characterize emergency department visits made by patients with cancer receiving chemotherapy and to describe associated outcomes.<h4>Methods</h4>This retrospective cohort study used population-based administrative data from Ontario, Canada. Patients aged 18 years and older, with a cancer diagnosis, and who received chemotherapy in the 30 days before being seen in ...[more]

PMID: 32792349

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Project description:BackgroundPeripregnancy emergency department use may be common, but data specific to health care systems like that in Canada are lacking. As prior research was limited to livebirths, omitting pregnancies ending in miscarriage or induced abortion, the current study quantified and characterized emergency department use among women in Ontario with a recognized pregnancy.MethodsThis retrospective population-based cohort study included all recognized pregnancies among Ontario residents aged 10-55 years with an estimated date of conception between Apr. 1, 2002, and Mar. 31, 2017. We defined peripregnancy emergency department use as any emergency department visit during pregnancy or within 42 days after pregnancy. We used modified Poisson regression with a robust error variance to generate relative risks (RRs) and 95% confidence intervals (CIs) for the outcome of any peripregnancy emergency department use in association with maternal age, parity, residential income quintile, location of residence, immigrant status, antenatal care provider and number of comorbidities within 120 days before the clinical start of the pregnancy (expressed as total number of Aggregated Diagnosis Groups [ADGs] obtained with the Johns Hopkins Adjusted Clinical Group System). All RRs, except for number of comorbidities, were further adjusted for number of ADGs.ResultsPeripregnancy emergency department use occurred in 1 075 991 (39.4%) of 2 728 236 recognized pregnancies, including 35.8% of livebirths, 47.3% of stillbirths, 73.7% of miscarriages and 84.8% of threatened abortions. A peripregnancy emergency department visit was more likely among women who were less than 25 years of age (adjusted RR 1.16, 95% CI 1.16-1.17), were nulliparous (adjusted RR 1.13, 95% CI 1.13-1.13), resided in the lowest income quintile area (adjusted RR 1.16, 95% CI 1.15-1.16) or in a rural area (adjusted RR 1.50, 95% CI 1.50-1.51), were Canadian-born (adjusted RR 1.22, 95% CI 1.22-1.23), were not seen by an obstetrician (adjusted RR 1.66, 95% CI 1.54-1.80) or had a greater number of ADGs. Emergency department use peaked in the first trimester and in the first week postpartum. Compared to women residing in urban areas, those residing in rural areas had an odds ratio (OR) of 3.44 (95% CI 3.39-3.49) for 3 or more emergency department visits. Women with 3-4 (OR 1.99, 95% CI 1.97-2.01), 5-6 (OR 3.55, 95% CI 3.49-3.61), or 7 or more (OR 7.59, 95% CI 7.39-7.78) prepregnancy comorbidities were more likely to have 3 or more peripregnancy emergency department visits than were those with 2 or fewer comorbidities.InterpretationPeripregnancy emergency department use occurred in nearly 40% of pregnancies, notably in the first trimester and early in the postpartum period. Efforts are needed to streamline rapid access to ambulatory obstetric care during these peak periods, when women are susceptible to miscarriage or a complication after a livebirth.

Project description:ImportanceEmergency department (ED) use in pregnancy is common and occurs for a variety of reasons, including obstetrical complications, exacerbated underlying conditions, and inadequate outpatient health care access. People with disabilities have elevated rates of certain medical, psychiatric, and obstetrical conditions as well as inadequate access to prenatal care; their risk of ED use in pregnancy is not known, however.ObjectiveTo compare the risk of ED use in pregnancy among people with physical, sensory, and intellectual or developmental disabilities with those without disabilities.Design, setting, and participantsPopulation-based cohort study leveraging linked administrative health data sets in Ontario, Canada, April 2003 to March 2019. Analysis included all recognized pregnancies to people with a preexisting physical, sensory, intellectual or developmental, or 2 or more (multiple) disabilities, and those without a disability. Data were analyzed from May 2022 to January 2023.ExposureDisability was ascertained using algorithms applied to 2 or more outpatient physician visits or 1 or more ED visits or hospitalizations before conception.Main outcomes and measuresModified Poisson regression-generated adjusted relative risks (aRR) and 95% CIs for any ED visit in pregnancy, from the estimated conception date up to the end of the pregnancy, adjusted for age, parity, income quintile, rurality, immigrant status, and preexisting chronic conditions, mental illness, and substance use disorders.ResultsThe cohort included 2 659 895 pregnant people with physical (221 739 participants; mean [SD] age, 29.8 [6.1] years), sensory (71 891 participants; mean [SD] age, 29.1 [6.4] years), intellectual or developmental (3877 participants; mean [SD] age, 26.1 [6.7] years), and multiple disabilities (14 359 participants; mean [SD] age, 29.5 [6.5] years), and pregnant people without a disability (2 348 023 participants; mean [SD] age, 29.4 [5.9] years). The rate of ED visits in pregnancy was 25.4% in people without a disability (596 771 visits). Relative to these individuals, the aRR for ED use was elevated in people with physical (aRR, 1.26; 95% CI, 1.25-1.27), sensory (aRR, 1.15; 95% CI, 1.14-1.17), intellectual or developmental (aRR, 1.33; 95% CI, 1.28-1.38), and multiple disabilities (aRR, 1.43; 95% CI, 1.40-1.46).Conclusions and relevanceIn this population-based study, people with disabilities were at elevated risk of ED use in pregnancy. This finding underscores the need for research on the benefits of proactive strategies to manage preexisting conditions in these individuals, improve their access to outpatient obstetrical and medical care, and prepare them for when ED visits occur.

Project description:ImportanceOpioids can impair motor skills and may affect the ability to drive; however, the association of opioid use with driving ability is not well established.ObjectiveTo examine the risk of motor vehicle collisions (MVCs) among drivers starting opioid therapy compared with that among drivers starting nonsteroidal anti-inflammatory drug (NSAID) therapy.Design, setting, and participantsThis population-based, retrospective cohort study included all residents of Ontario aged 17 years or older who started new prescription analgesic therapy between March 1, 2008, and March 17, 2019.ExposuresInitiation of opioid therapy or NSAID therapy, ascertained through prescription dispensing records in administrative data.Main outcomes and measuresThe primary outcome was an emergency department visit for injuries sustained as a driver in an MVC during the 14 days after starting analgesic therapy. Inverse probability treatment weighting was used to balance baseline covariates, and weighted Cox proportional hazards regression models were used to assess the association between new analgesic therapy and hazard of an emergency department visit after an MVC.ResultsOf the 1 454 824 individuals included in the study, 765 464 (52.6%) were new opioid recipients and 689 360 (47.4%) were new NSAID recipients. Most participants were aged 65 years or older (75.2%), and 55.2% were women. Of 194 individuals who had emergency department visits for injuries from an MVC within 14 days of initiating therapy, 98 (50.5%) were opioid recipients (3.41 per 1000 person-years; 95% CI, 2.80-4.15 per 1000 person-years) and 96 (49.5%) were NSAID recipients (3.64 per 1000 person-years; 95% CI, 2.98-4.45 per 1000 person-years). There was no significant difference in the risk of an emergency department visit for MVC injuries between opioid and NSAID recipients (weighted hazard ratio, 0.94; 95% CI, 0.70-1.25).Conclusions and relevanceThe findings of this study suggest that the hazard of an emergency department visit for injuries relating to an MVC as a driver is similar between individuals starting prescription opioids and those starting prescription NSAIDs. These results may be useful for patients, clinicians, and caregivers when considering new analgesic therapy.

Project description:BackgroundSubstance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces.MethodsThis was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015.ResultsIn 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37-43 years; 60.9-63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with "extreme" and "moderate" frequent visits (median 13-19 versus 4-6 visits/year). "Extreme" versus "moderate" subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups.ConclusionsSubgroups of people with "extreme" (13-19 visits/year) and "moderate" (4-6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the "extreme" subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare.

Project description:AbstractObjectivesTo describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department.DesignPopulation based cohort study.SettingEmergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019.ParticipantsAdults (≥18 years) attending emergency departments.Data sourcesLinked data from emergency departments, hospital discharges, and cancer registries, and national mortality data.Main outcome measuresMultimorbidity was defined as at least two conditions from the Elixhauser comorbidity index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30 day mortality (primary outcome), hospital admission, reattendance at the emergency department within seven days, and time spent in emergency department (secondary outcomes). Primary analysis was stratified by age (<65 v ≥65 years).Results451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 v 43 years), more likely to arrive by emergency ambulance (57.8% v 23.7%), and more likely to be triaged as very urgent (23.5% v 9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2% v 1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1% v 20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8% v 3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older.ConclusionsAlmost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.

Dataset Information

Outcomes after emergency department use in patients with cancer receiving chemotherapy in Ontario, Canada: a population-based cohort study.

Background

Methods

Results

Interpretation

Publications

Outcomes after emergency department use in patients with cancer receiving chemotherapy in Ontario, Canada: a population-based cohort study.

Similar Datasets

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