Date of Award

2021-05-22

Degree Name

PhD Nursing

Dissertation Committee

Caroline Etland, PhD, RN, CNS, AOCN, ACHPN, Chairperson; Cynthia D. Connelly, PhD, RN, FAAN, Committee Member; Laurie Ecoff, PhD, RN, NEA-BC, CNL, Committee Member

Keywords

Oncology Nurse Navigator, Chemotherapy Measure, Outpatient Chemotherapy, Emergency Department Visit, Hospital Admissions

Abstract

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient chemotherapy.

Purpose: The purpose of this study was to examine the contribution of the ONN in ED visits and hospitalizations for adult cancer patients post outpatient chemotherapy. The three research aims provide a foundation to generate new scientific knowledge towards the improvement of understanding the role of the ONN in ED visits and hospital admissions for adult patients with cancer post outpatient chemotherapy. Aim 1: Describe patient sociodemographics (age, race, gender, language spoken at home, primary health insurance, cancer diagnosis, and admission source), care site characteristics (outpatient chemotherapy administration location, ED visit facility location, and hospital admission facility location), the ONN’s involvement, ED visits and/or hospital admissions with any of ten chemotherapy related conditions. Aim 2: 2a: Examine relationships among sociodemographics, care site characteristics, the ONN involvement, ED visits, and hospitalizations. 2b: Describe the difference in ED visits and hospital admissions between the ONN involved and non-ONN involved groups. Aim 3: 3a: Identify factors (sociodemographics, care site characteristics, and the ONN) that explain the amount of variance in ED visits; 3b: Identify factors (sociodemographics, care site characteristics, and the ONN) that explain the amount of variance in hospitalizations.

Method: Descriptive correlational design using retrospective EHR data collected from January 1, 2018 to December 31, 2019. Descriptive and inferential statistical approaches were used to analyze the data.

Results: Approximately 35% of patients who had outpatient chemotherapy had an ED visit and/or a hospital admission. The most common conditions noted were anemia, dehydration, and pain. Medicare insurance, chemotherapy location, dehydration, diarrhea, emesis, and neutropenia were significantly related number of ED visits. Hospital length of stay, anemia, dehydration, fever, nausea, neutropenia, pain, pneumonia, and sepsis were significantly related to number of hospitalizations. There was no significant difference in number of ED visits and hospitalization between ONN vs. non-ONN groups. The multiple regression model showed Medicare insurance and chemotherapy location significantly contributed to the predictive model for ED visits. Nausea, pain, and pneumonia significantly contributed to the predictive model for number of hospital admissions.

Implications for Nursing Research: The study findings indicated that the chemotherapy measure metrics, such as ED visits and hospital admissions, were not appropriate clinical outcomes to measure the ONN’s efficacy. Navigating cancer treatment is the primary role function of the ONN, rather than daily symptom management and intervention. Additional research is necessary to understand the fiscal and operational outcomes of the ONN, including using a longitudinal design to measure over the cancer continuum.

Document Type

Dissertation: Open Access

Department

Nursing

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