Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Cambia Health Solutions, Seattle; MultiCare Regional Cancer Center, Tacoma; and Premera Blue Cross, Mountlake Terrace, WA Corresponding author: Laura Panattoni, PhD, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109; e-mail: lpanatto@ fredhutch.org. Disclosures provided by the authors are available with this article at jop.ascopubs.org. DOI: https://doi.org/10.1200/JOP. 2017.028191; published online ahead of print at jop.ascopubs.org on February 8, 2018. Characterizing Potentially Preventable Cancer- and Chronic Disease–Related Emergency Department Use in the Year After Treatment Initiation: A Regional Study Laura Panattoni, Catherine Fedorenko, Mikael Anne Greenwood-Hickman, Karma Kreizenbeck, Julia R. Walker, Renato Martins, Keith D. Eaton, John W. Rieke, Ted Conklin, Bruce Smith, Gary Lyman, and Scott D. Ramsey QUESTION ASKED: How do different methods compare for evaluating the preva- lence and costs of potentially preventable (PP) emergency department (ED) use related to cancer and chronic disease among a com- mercially insured oncology population in the year after the initiation of chemotherapy or radiation? SUMMARY ANSWER: On the basis of pri- mary diagnosis coding, 49.8% of ED visits had a PP cancer-related diagnosis, whereas 3.2% had a PP chronic disease–related diagnosis. Considering all diagnosis fields, 45.0%, 9.4%, and 18.5% included a PP cancer-related di- agnosis only, a PP chronic disease–related diagnosis only, and both types of diagnoses, respectively. WHAT WE DID: We categorized all ED visits 1 year after treatment initiation for commer- cially insured oncology patients diagnosed with a solid tumor in western Washington from 2011 to 2016. Cancer symptoms from the Centers for Medicare & Medicaid Services (CMS) metric and a patient-reported outcome intervention were labeled PP cancer related. Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators were labeled PP chronic disease related. WHAT WE FOUND: The prevalence of PP ED visits was generally high, but varied depending on the diagnosis code fields and the group of codes considered. BIAS, CONFOUNDING FACTOR(S), REAL- LIFE IMPLICATIONS: Claims records are imperfect proxies for clinical situations in complex conditions, such as cancer. Extrapo- lation of these findings to Medicare, Medicaid, or other regional populations should be done with caution. This study did not reproduce the exact CMS or AHRQ metrics—for example, population and performance periods were different—but rather used the PP code lists. We are unaware of any validation study that has reported that CMS codes are preventable or that the AHRQ Prevention Quality Indicator codes are preventable in an oncology population. The Medicare Access and CHIP Reau- thorization Act, the Oncology Care Model, and the wider policy movement in oncology is focused on improving quality and reducing avoidable use. These initiatives measure and reimburse organizations on the basis of all- cause ED use, raising the need to consider the strengths and weaknesses of using a PP ED metric. Validation studies are critical to de- termine the best uses for and the methodologic approach to measuring PP ED visits. In ad- dition, future research is needed to understand the complex landscape of PP ED visits and measures to inform their role in value-based purchasing and guiding oncology care transformation. ReCAPs (Research Contributions Abbreviated for Print) provide a structured, one-page summary of each paper highlighting the main findings and significance of the work. The full version of the article is available online at jop.ascopubs.org. Copyright © 2018 by American Society of Clinical Oncology Volume 14 / Issue 3 / March 2018 n jop.ascopubs.org 165 Original Contribution FOCUS ON QUALITY Original Contribution FOCUS ON QUALITY Downloaded from ascopubs.org by 3.238.124.89 on June 7, 2022 from 003.238.124.089 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.