Hospital Utilization of Patients with Cervical Cancer

Wednesday, 24 July 2013

Worranan Prasanatikom, RN, PhD
Utilization Management Unit, Dean Office, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Learning Objective 1: To be able to verbalize the indicators of utilization management.

Learning Objective 2: To be able to explaine the different length of stay of the patients with cancer treatments.

Utilization review is a part of nurses’ role in case management.  Since the Diagnostic Related Groups introduced in the health economic, length of stay and readmission have been studied. Cervical cancer is one of the high-cost-high-volume diseases that has consumed large amount of hospital resources. Though data of this disease have been collected in the hospital data base, transforming these data to evidence-based has never been done.

Purpose:  The study was to explore hospital utilization of patients with cervical cancer.

Methods:  The data of the retrospective study with secondary analysis were extracted from the Hospital Information System at the Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. The sample included 2804 cases of patients with the principal diagnosis of cervical cancer from 2005 – 2011.

Results: The number of patients with cervical cancer increased from 211 cases in 2005 to 423 cases in 2011. An average age was 52 ± 10.10 years and very few patients were private patients. Admission assessment showed that only 2.6% were unplanned readmission related to principal diagnosis within 28 days. The length of stay (los) varied from 1-89 days and the mean was 3 ± 5.47 days. Sixty two percents of the patients had los of 1 day and 92% within this group were treated with chemotherapy and radiotherapy with chemotherapy.  The means los of radiotherapy, surgery, and chemotherapy alone were 12, 7 and 4 days, respectively. The patients who needed investigations and symptomatic treatment had average los of 7 ± 8.23 days.

Conclusion: Comparing to the treatment protocol, there were appropriate uses of hospital resource. Longer length of stay due to waiting time for radiation or investigation should be considered the option of ambulatory care. Effective concurrent utilization review and discharge planning will decrease los in palliative patients.