Stopping the revolving door: An exploratory analysis of health care super-utilization in gynecologic oncology

• Published in: Gynecologic oncology reports Vol. 37; p. 100789
• Main Authors: Zivanov, Catherine N., Apple, Annie, Brown, Alaina J., Robinson, Marc A., Prescott, Lauren S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-08-2021; Elsevier
• Subjects: Gynecologic cancer; Gynecologic oncology; Health care utilization; Hospital readmission; Research Report; Super-utilizer; Gynecologic oncology; Health care utilization; Hospital readmission; Gynecologic cancer; Super-utilizer
• ISSN: 2352-5789; 2352-5789
• DOI: 10.1016/j.gore.2021.100789

•Less than 10% of gynecologic oncology patients account for the majority of unplanned hospital encounters and readmissions.•The majority of health care utilization occurred during the first year of diagnosis.•Risk factors for health care super-utilization included Medicaid insurance, disease status, and ASA classification.•Exploratory analysis suggests an opportunity to decrease health care utilization, particularly during upfront treatment.
The objective of this study was to determine the prevalence of and risk factors for health care super-utilization among gynecologic oncology patients at a single academic hospital. A retrospective cohort study of gynecologic oncology patients with an index unplanned encounter between January and December 2018 was performed. Super-utilizers were defined as patients with 3 or more unplanned hospital encounters during a 12-month period starting at the time of the index unplanned encounter. We identified 553 patients with gynecologic cancer. Of those, 37(7%) met inclusion criteria for super-utilizers accounting for 193/310(62%) of unplanned visits. The median number of unplanned visits was 4 (range 3–24). The most common cancers were uterine (N = 15 (41%)) and ovarian (N = 11 (30%)). Nineteen (51%) super-utilizers had advanced stage disease. Phases of oncologic care at index unplanned encounter included primary diagnosis (N = 24 (65%)), recurrence (N = 10 (27%)), and surveillance (N = 2 (5%)). Twelve super-utilizers (32%) had new diagnoses of cancer without prior therapy, 19(51%) had prior chemotherapy, 17(46%) had prior surgery, and 10(27%) had prior radiation therapy at the time of initial encounter. Fifteen super-utilizers (41%) were in the last year of life. The most common reasons for unplanned encounters were pain (66%) and gastrointestinal symptoms (61%). Multivariable analysis adjusting for key variables demonstrated that Medicaid insurance, ASA classification, and disease status are risk factors for health care super-utilization. The majority of health care utilization occurred during the first year of diagnosis. This exploratory analysis suggests an opportunity to decrease health care utilization, particularly during upfront treatment.