HSR20-081: The Direct Referral Unit: Clinical Outcomes and Experience With a Specialized Urgent Care Center for Oncology Patients

Background: The oncology population is associated with significant healthcare utilization and high rates of emergency department (ED) visits and inpatient admission. Oncologic urgent care centers represent a way to triage patients and prevent admissions. Fox Chase Cancer Center (FCCC) developed an urgent care center, the direct referral unit (DRU), in 2012. We sought to characterize the experience of the DRU and its impact on clinical outcomes and utilization. Methods: We abstracted data for patients at FCCC with a minimum of three outpatient visits and who received treatment (chemotherapy, radiation, immunotherapy, and/or surgery) with an index visit (Jeanes ED or FCCC DRU) between January 2014 and June 2018. Inpatient admissions to FCCC were also captured. ED visit rates were calculated as a proportion of the number of ED visits over FCCC patient clinic visits per year. We also assessed cost of index visit, receipt of systemic therapy, admission rate, length of stay (LOS) for admission, and the number of patients with an admission within 30 days of an index visit. Regressions with robust cluster corrected standard errors were used for analyses. Results: Our analysis showed that index visits occurring in the ED increased over time while visits to the DRU decreased (p <0.001). Inpatient admission was more likely from the DRU than the ED but most commonly occurred if a patient had a visit to both (p<0.001 among groups). 30 day admissions after index visits were similar among the DRU and ED and highest among patients with index visits to both (p<.001). Total LOS was not significantly different with regard to index visit location (p = 0.97). The total charges per index visit were lower for the DRU compared to ED (mean $2,219 vs $10,253; p <0.001). Patients presenting to the DRU received systemic therapy within 30 days of the visit more frequently than those presenting to the ED, with frequency highest among those who presented to both (p = <0.001). Conclusions: ED visit rates increased over time despite access to the DRU. This may demonstrate the increasing needs of a complex patient population, in addition to the potential need for enhanced access to the DRU. Cost savings for patients who present to the DRU, as opposed to the ED, is remarkable and should be explored. The complexity of toxicity and cancer-related symptom management necessitates access to care teams who can provide customized, cost conscious diagnostic and therapeutic management.

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Corresponding Author: Christopher D'Avella, MD
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