Abstract
Background
Palliative care involvement in cancer care has demonstrated benefits in end-of-life outcomes, but its impact on upstream healthcare utilization in diverse populations remains understudied.
Aim
To investigate the effect of supportive oncology consultation on upstream acute care utilization.
Design
This was a retrospective cohort study. Healthcare utilization was measured as emergency department (ED) visits and hospitalizations within 90 days before and after the first appointment. Patients with high healthcare utilization (HHCU) were defined as patients in the top 10% of combined ED visits and hospitalizations pre-consultation. Paired t-tests compared utilization before and after supportive oncology initiation.
Setting/Participants
The study included 682 patients with metastatic solid tumors who attended their first supportive oncology appointment at Mount Sinai Health System between January 2021 and June 2023.
Results
The cohort was ethnically diverse. No significant demographic or clinical differences distinguished HHCU from other patients at baseline. Overall, ED visits decreased significantly after supportive oncology consultation (0.28 vs 0.19 visits per 90-day period, P < .001), while hospitalizations showed no significant change. Among patients with HHCU (n = 44), the apparent impact was more pronounced: ED visits decreased by 78% (1.75 vs 0.39 visits, P < .001) and hospitalizations by 53% (1.59 vs 0.75 stays, P < .001). However, these reductions were largely explained by regression to the mean.
Conclusions
Supportive oncology consultation was associated with reduced ED utilization in the overall cohort. Apparent dramatic reductions among patients with high utilization were largely explained by regression to the mean, highlighting the need for randomized controlled trials to definitively assess intervention effects in this population.
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