Purpose Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. Methods Individuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. Results In the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). Conclusion Individuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.

中文翻译：

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晚期癌症患者诊断后一年内的住院率和再住院预测因素


目的 在晚期癌症患者中，频繁住院越来越被视为护理质量差的标志。我们检查了晚期癌症患者诊断后一年内的住院率以及个体和医院层面的再住院预测因素。方法 根据加州癌症登记处 (CCR) 的数据，对 2009 年至 2012 年诊断为晚期乳腺癌、结直肠癌、非小细胞肺癌或胰腺癌的个体 (N = 25,032) 进行了识别。与住院患者出院数据联系起来后，使用多状态和对数线性泊松回归模型来计算住院率，并为诊断后一年的再住院建模，并考虑生存率。结果 在诊断后一年内，71% 的晚期癌症患者住院治疗，16% 的患者住院 3 次或以上，64% 的住院患者来自急诊科。再住院率与非西班牙裔黑人（发病率比 [IRR]，1.29；95% CI，1.17 至 1.42）和西班牙裔（IRR，1.11；95% CI，1.03 至 1.20）种族/民族显着相关；公共保险（IRR，1.37；95% CI，1.23 至 1.47）和无保险（IRR，1.17；95% CI，1.02 至 1.35）；社会经济地位较低的五分位数（IRR，1.09 至 1.29）；合并症（IRR，1.13 至 1.59）；胰腺癌（IRR，2.07；95% CI，1.95 至 2.20）和非小细胞肺癌（IRR，1.69；95% CI，1.54 至 1.86）与结直肠癌的比较。从设有门诊姑息治疗计划的医院出院后，再住院率显着较低（IRR，0.90；95% CI，0.83至0.97），而从营利性医院出院后，再住院率则较高（IRR，1.33；95% CI， 1.14 至 1.56）。 结论 晚期癌症患者在诊断后一年内会经历沉重的住院负担。减少住院治疗并提供符合患者偏好的护理的努力可能会针对高风险人群。未来的工作可能会探索在社区中获得姑息治疗的机会以及晚期癌症患者的相关医疗保健使用情况。