The American Journal of Managed Care August 2014
Effects of Multidisciplinary Team Care on Utilization of Emergency Care for Patients With Lung Cancer
The lung cancer patients participating in MDT had lower risk to visit an ED (OR = 0.89; 95% CI, 0.80-0.98), and the incidence rate ratio decreased by 11% (95% CI, –0.15 to –0.07). Gender, monthly salary, urbanization of the residence area, comorbid conditions, catastrophic illness/injury, treatment method, number of outpatient visits, length of stay,
Am J Manag Care. 2014;20(8):e353-e364
Multidisciplinary team care can improve the effectiveness of care for lung cancer patients.
The incidence rate ratio of emergency department (ED) visits decreased 11% for lung cancer patients participating in MDT care.
- The primary cause of ED visits was fever for both the MDT participants (25.46%) and non-MDT participants (23.97%).
Worldwide, lung cancer is the most common cancer in terms of both incidence and mortality. In 2012, there were 1.8 million new cases and 1.59 million deaths caused by lung cancer.1 Since 1998, lung cancer has been the leading cause of cancer death in Taiwan and worldwide.2 Although progress has been made in the diagnosis and treatment of lung cancer, both the incidence and mortality rate of lung cancer have increased in recent years. Formal multidisciplinary team (MDT) care has been widely promoted worldwide to improve coordination, communication, and decision making in cancer management.3,4
The Taiwan bureau of National Health Insurance has implemented “multidisciplinary team care for cancer patients” since April 2003 to enhance the quality of cancer diagnosis and treatment. The bureau emphasizes an MDT approach that provides a complete cancer treatment plan for patients. MDT care goes beyond such conventional treatments forlung cancer as surgical excision, radiation therapy, and chemotherapy. The MDT members can include related clinical physicians, nursing staff, a psychological consultant, a social worker, and a case manager to discuss a dedicated treatment plan and to integrate all treatments and care. Therefore, the patient with MDT care should benefit from stable and continuous care that includes regular outpatient visits and inpatient treatment, all arranged and coordinated through the case manager. The Bureau of National Health Insurance (NHI) paid additional fees to physicians to make MDT care financially appealing.
The MDT approach has been used for years in numerous countries. Studies from the United States, Germany, the United Kingdom, and Australia have demonstrated that an MDT that integrates surgeons, tumor physicians, radiology physicians, psychologists, physiatrists, and dietitians can improve the quality of life for cancer patients,5 lower the cost of healthcare,6 and increase the satisfaction of treatment for patients,6 efficiency of treatment,4,5,7,8 and survival rate.9,10 In Taiwan, Wang et al found the relative risk of death was lower for oral cavity cancer in MDT care participants.4 Chen et al found that chronic kidney disease patients who participated in MDT had a better survival rate than nonparticipants have initiate renal replacement therapy instead of after MDT intervention.11
Hospital emergency departments (EDs) are typically designed to manage emergent or unexpected situations and are generally crowded and busy.12 As detailed in 1 study, in North Carolina in 2008, 0.9% of ED visits were cancer related; 7.7% of the state’s cancer survivors visited the ED; and each ED visitor received 1.4 ED services per year on average.13 In Taiwan, in 2012, 1.9% of ED visits were cancer related.14 The reasons cancer patients seek ED services include pain, dyspnea, nausea, and vomiting, among others. 13,15 Among cancer patients, lung cancer patients are, as a group, the likeliest of all to seek ED services.13 The main reasons that prompt the visits of lung cancer patient to EDs include respiratory symptoms, fever, neurological/ psychiatric issues, and digestive complaints.16
The high percentage of ED visits for cancer patients has been recognized as an indicator that end-of-life cancer care is of less-than-ideal quality. Better care, it is believed, could help cancer patients avoid at least some of the urgent medical problems that necessitate ED visits. Most studies on lung cancer in MDT care have been limited, sometimes because the sample size was small and sometimes because the focus was narrowly on survival. Few studies have examined the changes in the utilization of ED services after patients have become involved in MDT care. Therefore, this study investigates the influence of the participation and nonparticipation of patients in MDT care on the utilization of ED visits.