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The American Journal of Managed Care August 2014
Personalized Preventive Care Reduces Healthcare Expenditures Among Medicare Advantage Beneficiaries
Shirley Musich, PhD; Andrea Klemes, DO, FACE; Michael A. Kubica, MBA, MS; Sara Wang, PhD; and Kevin Hawkins, PhD
Impact of Hypertension on Healthcare Costs Among Children
Todd P. Gilmer, PhD; Patrick J. O'Connor, MD, MPH; Alan R. Sinaiko, MD; Elyse O. Kharbanda, MD, MPH; David J. Magid, MD, MPH; Nancy E. Sherwood, PhD; Kenneth F. Adams, PhD; Emily D. Parker, MD, PhD; and Karen L. Margolis, MD, MPH
Tracking Spending Among Commercially Insured Beneficiaries Using a Distributed Data Model
Carrie H. Colla, PhD; William L. Schpero, MPH; Daniel J. Gottlieb, MS; Asha B. McClurg, BA; Peter G. Albert, MS; Nancy Baum, PhD; Karl Finison, MA; Luisa Franzini, PhD; Gary Kitching, BS; Sue Knudson, MA; Rohan Parikh, MS; Rebecca Symes, BS; and Elliott S. Fisher, MD
Potential Role of Network Meta-Analysis in Value-Based Insurance Design
James D. Chambers, PhD, MPharm, MSc; Aaron Winn, MPP; Yue Zhong, MD, PhD; Natalia Olchanski, MS; and Michael J. Cangelosi, MA, MPH
Massachusetts Health Reform and Veterans Affairs Health System Enrollment
Edwin S. Wong, PhD; Matthew L. Maciejewski, PhD; Paul L. Hebert, PhD; Christopher L. Bryson, MD, MS; and Chuan-Fen Liu, PhD, MPH
Contemporary Use of Dual Antiplatelet Therapy for Preventing Cardiovascular Events
Andrew M. Goldsweig, MD; Kimberly J. Reid, MS; Kensey Gosch, MS; Fengming Tang, MS; Margaret C. Fang, MD, MPH; Thomas M. Maddox, MD, MSc; Paul S. Chan, MD, MSc; David J. Cohen, MD, MSc; and Jersey Chen, MD, MPH
Potential Benefits of Increased Access to Doula Support During Childbirth
Katy B. Kozhimannil, PhD, MPA; Laura B. Attanasio, BA; Judy Jou, MPH; Lauren K. Joarnt; Pamela J. Johnson, PhD; and Dwenda K. Gjerdingen, MD
Synchronization of Coverage, Benefits, and Payment to Drive Innovation
Annemarie V. Wouters, PhD; and Nancy McGee, JD, DrPH
The Effect of Depression Treatment on Work Productivity
Arne Beck, PhD; A. Lauren Crain, PhD; Leif I. Solberg, MD; Jürgen Unützer, MD, MPH; Michael V. Maciosek, PhD; Robin R. Whitebird, PhD, MSW; and Rebecca C. Rossom, MD, MSCR
Economic Implications of Weight Change in Patients With Type 2 Diabetes Mellitus
Kelly Bell, MSPhr; Shreekant Parasuraman, PhD; Manan Shah, PhD; Aditya Raju, MS; John Graham, PharmD; Lois Lamerato, PhD; and Anna D'Souza, PhD
Optimizing Enrollment in Employer Health Programs: A Comparison of Enrollment Strategies in the Diabetes Health Plan
Lindsay B. Kimbro, MPP; Jinnan Li, MPH; Norman Turk, MS; Susan L. Ettner, PhD; Tannaz Moin, MD, MBA, MSHS; Carol M. Mangione, MD; and O. Kenrik Duru, MD, MSHS
Does CAC Testing Alter Downstream Treatment Patterns for Cardiovascular Disease?
Winnie Chia-hsuan Chi, MS; Gosia Sylwestrzak, MA; John Barron, PharmD; Barsam Kasravi, MD, MPH; Thomas Power, MD; and Rita Redberg MD, MSc
Currently Reading
Effects of Multidisciplinary Team Care on Utilization of Emergency Care for Patients With Lung Cancer
Shun-Mu Wang, MHA; Pei-Tseng Kung, ScD; Yueh-Hsin Wang, MHA; Kuang-Hua Huang, PhD; and Wen-Chen Tsai, DrPH

Effects of Multidisciplinary Team Care on Utilization of Emergency Care for Patients With Lung Cancer

Shun-Mu Wang, MHA; Pei-Tseng Kung, ScD; Yueh-Hsin Wang, MHA; Kuang-Hua Huang, PhD; and Wen-Chen Tsai, DrPH
Impact of multidisciplinary team care on reducing utilization of emergency department visits for patients with lung cancer.
To improve the quality of care, multidisciplinary team (MDT) care was implemented in Taiwan. This study examined the relationship between MDT care and emergency department (ED) visits for lung cancer patients.

Study Design
A retrospective cohort study with MDT care participants and matched a double number of control group of non-participants was followed.

In this study, 22,817 patients with newly diagnosed lung cancer were recruited from 2005 to 2007 in Taiwan. Matching based on the propensity of receiving MDT care was used. A total of 8172 patients were observed in this study. A c2, ANOVA, logistic regression, and Poisson regression were used to elucidate the effects of MDT care.

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,
hospital ownership, level of hospital, and the age of the patient’s physician were all significantly related to the frequency of ED visits (P <.05).

The frequency of ED visits of patients with MDT care was lower than that of those without it. The patients with MDT received enhanced care.

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.


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