HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Douglas E. Wood Thomas K. Varghese Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Farjah, F. Articles by Flum, D. R. Search for Related Content PubMed PubMed Citation Articles by Farjah, F. Articles by Flum, D. R. Related Collections Lung - cancer Professional affairs

---

Original Articles: General Thoracic

Health Care Utilization Among Surgically Treated Medicare Beneficiaries With Lung Cancer

Department of Surgery, University of Washington, Seattle, Washington

Accepted for publication August 6, 2009.

^_* Address correspondence to Dr Flum, University of Washington, Department of Surgery, Box 356410, 1959 NE Pacific St, Seattle, WA 98195-6410 (Email: daveflum{at}u.washington.edu).

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.