High Variation in Readmissions May Suggest Need For Better Lung Cancer Diagnostics in New York
In Lung Cancer
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By: James Pitt May. 29, 2018
Lung cancer rates are falling, but it remains the leading cause of cancer deaths in the US. Detecting cancer early can improve survival. But in recent years, overdiagnosis became a concern. The only lung cancer screen the CDC recommends is low dose CT (LDCT). But even LDCT picks up many findings that may not be dangerous. A 2016 randomized clinical trial in The Lancet Oncology found that only 4% of new solid nodules detected on LDCT were lung cancer.
One solution is to follow LDCT with bronchoscopy and a genomic classifier. A 2017 cost-effectiveness analysis in Journal of Thoracic Oncology found that this would reduce invasive procedures by 28% at one month and 18% at 2 years at about equal cost.
To ascertain the need for better lung cancer diagnostics, Dexur analysts examined all-cause 30-day readmissions in CMS discharge data. The study population was patients discharged with respiratory neoplasms in New York hospitals with over 10,000 discharges per year. Readmission rates for patients with respiratory neoplasms major complications (DRG 180) varied widely across hospitals. The highest 30-day readmission rate was 43% at Montefiore Medical Center; the lowest, 25% at Mt. Sinai. Staten Island University Hospital also had a low readmission rate, 26%.
Albany Medical Center and Stony Brook University Hospital were the only such hospitals outside the vicinity of New York City.
Lung cancer patients had higher readmission rates than the general population.
Hospitals varied in the risks of their populations. No hospital reported more than 11 patients with respiratory neoplasm with no complications (DRG 182). The proportion of patients with major complications was highest at North Shore University Hospital (1.74:1), and lowest at Montefiore Medical Center.
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- Total discharges
- Discharges after exclusion
- All-cause 30-day readmissions
- % of 30-day readmissions back to the same hospital
- All-cause 30-day readmission rate
For all inpatients; all inpatients with respiratory neoplasms; and at DRG level for DRGs 180 and 181.
At Montefiore Medical Center (Bronx, NY), Staten Island University Hospital - North Campus (Staten Island, NY), North Shore University Hospital (Manhasset, NY), Stony Brook University Hospital (Stony Brook, NY), Albany Medical Center (Albany, NY), Mt. Sinai Hospital (1 Gustave Levy Place, New York, NY), New York Presbyterian/ Columbia University Medical Center (622 West 168th St, New York, NY), NYU Langone - Tisch Hospital (New York, NY), and New York Presbyterian/ Weill Cornell Medical Center (525 East 68th St, New York NY).
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