Potentially avoidable hospitalizations in older patients with acute myeloid leukemia (AML).

206 Background: Many older adults ( ≥ 60) with AML have a poor prognosis and spend a significant portion of their life from diagnosis until death in the hospital. We examined the reasons for hospitalizations and identified potentially avoidable hospitalizations. Methods: We conducted a retrospective analysis of 200 patients ( ≥ 60) diagnosed with AML between 1/1/2006 and 10/30/2011 at two hospitals in Boston to examine the reasons for hospitalizations during treatment. Practicing physicians used a consensus-driven medical record review process to identify primary reason for each hospitalization and categorize it as “potentially avoidable” or “not avoidable” based on a novel adaptation of the Graham’s criteria for potentially avoidable hospital admissions. We compared the rate of potentially avoidable hospitalization between older patients receiving intensive chemotherapy (n = 124) versus non-intensive chemotherapy (n = 76) using Fisher’s Exact test. Results: We evaluated 627 hospitalizations after the diagnosis of AML in 200 unique patients. The median age was 69 years [range 60-90] and the median number of hospitalizations was 4.0 [range 0-18]. 33.2% of patients underwent stem cell transplantation. The most common primary reasons for hospitalizations were: fever/infection (38.3%), planned hospitalizations for chemotherapy or transplantation (35.9%), and uncontrolled symptoms (10.5%). We identified 108/627 hospitalizations (17.2%) as potentially avoidable. Among potentially avoidable hospitalizations, 40.7% were due to premature hospital discharge, 22.2% could have been managed in the outpatient setting, 13.9% failed to have timely outpatient follow-up, and 13% were due to patients’ medication non-adherence. There were no differences in potentially avoidable hospitalizations between patients receiving intensive vs. non-intensive chemotherapy (16.9% vs. 17.8%, P = 0.83). Conclusions: Most hospitalizations in older patients with AML are unavoidable and driven by the illness course and its treatments. However, a minority of hospitalizations is potentially avoidable and should be the focus of future interventions to reduce health care utilization and the burden of AML on this population.

Duke Scholars

Author Thomas William LeBlanc Medicine, Hematologic Malignancies and Cellular Therapy