Portal de Periódicos da CAPES

Health Care Utilization Among Surgically Treated Medicare Beneficiaries With Lung Cancer

2009; Elsevier BV; Volume: 88; Issue: 6 Linguagem: Inglês

10.1016/j.athoracsur.2009.08.006

1552-6259

Farhood Farjah, Douglas E. Wood, Thomas K. Varghese, Nader N. Massarweh, Rebecca Symons, David R. Flum,

Pancreatic and Hepatic Oncology Research

Background Markers of increased health care utilization are surrogates for adverse events, and one such metric—prolonged length of stay greater than 14 days (PLOS)—was recently endorsed as a provider-level performance measure. Methods This is a cohort study (1992 through 2002) aimed to describe increased health care utilization among 21,067 operated lung cancer patients using the Surveillance, Epidemiology, and End-Results-Medicare database. Increased utilization was defined by PLOS, discharge to an institutional care facility (ICF), or readmission within 30 days. Results Twelve percent of patients had a PLOS, 13% were discharged to an ICF, and 15% were readmitted. In multivariate analyses, factors associated with a higher odds ratio of PLOS, discharge to ICF, or readmission included age older than 80 years, increasing comorbidity index, not being married, and pneumonectomy (all p < 0.05). Relative to patients living in the West, those in the Midwest or South had a higher odds ratio of PLOS and readmission but a lower odds ratio of discharge to an ICF (all p < 0.05). Adjusted rates of PLOS decreased significantly with time, whereas adjusted ICF and readmission rates increased (all p < 0.01). Patients who required increased utilization had higher adjusted 2.5-year mortality rates compared with those who did not (PLOS, 42% versus 20%; ICF, 32% versus 20%; readmission, 33% versus 19%; all p < 0.001). Conclusions Baseline health status and nonclinical factors were associated with increased utilization, nonuniform trends in utilization were observed with time, and increased utilization was associated with worse long-term outcomes. These findings have implications for quality-improvement initiatives that measure increased health care utilization as a surrogate for provider performance.