Dr. John Sweetenham, Associate Director for Clinical Affairs at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, has papers on cancer patients’ use of emergency departments featured at the annual meeting of the American Society of Clinical Oncology.
Cancer patients’ visits to the ED for acute complications of their underlying illness or its treatment is a significant issue, with an estimated 4.5 million visits in the U.S. annually, said Dr. Sweetenham, a Professor of Internal Medicine. Data from the Simmons Cancer Center’s participation in the Oncology Care Model showed a high rate of ED utilization by Medicare beneficiaries, with an all-cause risk-adjusted ED use of 28.1 to 29.9 percent.
To address the high rate of ED use, Simmons Cancer Center leadership developed an advanced practice provider-led oncology acute care clinic in August 2020. Using clinical pathways derived from existing evidence-based guidelines, 165 scheduled visits took place from August 2020 to December 2020, predominantly for patients with hematologic or gastrointestinal malignancies. The most common presenting symptoms were gastrointestinal. Of the 165 visits, 141 resulted in the patient being discharged home, 14 resulted in hospital admittances, and 10 were sent to the ED for a higher level of care. For conditions where care pathways were available, compliance with the pathways was 100 percent. Preliminary data demonstrate this clinic is highly effective at reducing unnecessary ED visits, Dr. Sweetenham said, with resulting improvements in patient-centered care and experience. The potential health economic impact of this clinic is currently being evaluated.
The annual meeting of the American Society of Clinical Oncology also features an abstract from Dr. Robin T. Higashi, Instructor of Population and Data Sciences and an associate member of UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, and Dr. Jasmin Tiro, Associate Professor of Population and Data Sciences and Associate Director for Community Outreach, Engagement, and Equity in the Simmons Cancer Center. In a multimodal review of online documents, Drs. Higashi and Tiro evaluated the equity of information from seven North Texas health care institutions about COVID-19 and cancer to English- and Spanish-speaking viewers. They found significant differences in thematic content, poor linkage to external Spanish content from English websites, and errors in Spanish translation. Given the disproportionate impact of COVID-19 on Latino populations, this lack of equitable access to timely information for Spanish speakers leaves an already vulnerable patient population at greater risk for poor health outcomes, the authors said. The paper provides several recommendations for institutions to enhance equitable access to online information to Spanish speakers.