Burden of Multiple Chronic Conditions Among Urologic Cancer Patients

To describe age, multiple chronic condition (MCC) profiles, and health system contact in urologic cancer patients.

Using Geisinger Health System electronic health records, we identified adult primary care patients and a subset with at least one urology encounter between 2001-2015. Agency for Healthcare Research and Quality Chronic Condition Indicator and Clinical Classifications Software tools were applied to International Classification of Diseases, Ninth Revision (ICD-9) codes to identify chronic conditions. MCC was defined as two or more chronic conditions. Urologic cancer patients were identified using ICD-9 codes for prostate, bladder, kidney, testis, and penile cancer. Inpatient and outpatient visits in the year prior to the most recent encounter were counted to document health system contact.

We identified 357,100 primary care and 33,079 urology patients, of which 4023 had urologic cancer. Urologic cancer patients were older (71y) than primary care (46y) and had more median chronic conditions (7 vs 4). Kidney and bladder cancer had the most median chronic conditions (8). Coronary artery disease and chronic kidney disease were common in urologic cancer compared to mental health conditions in primary care. Urologic cancer patients with MCC had the most health system contact. 32% had at least one hospitalization and 68% had >5 outpatient visits over 1 year.

Urology patients are older and more medically complex, and urologic cancer patients are especially more medically complex as compared to primary care. This data may inform care redesign to reduce treatment burden and improve care coordination in urologic cancer.

The Journal of urology. 2017 Aug 05 [Epub ahead of print]

Tullika Garg, Amanda J Young, Korey A Kost, John F Danella, Sharon Larson, Matthew E Nielsen, H Lester Kirchner

Department of Urology, Geisinger Health System, Danville, PA; Department of Health Services Research & Epidemiology, Geisinger Health System, Danville, PA. Electronic address: ., Biostatistics Core, Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA., Phenomic Analytics & Clinical Data Core, Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA., Department of Urology, Geisinger Health System, Danville, PA., Department of Health Services Research & Epidemiology, Geisinger Health System, Danville, PA., Department of Urology, University of North Carolina-Chapel Hill, Chapel Hill, NC., Biomedical & Translational Informatics Institute, Geisinger Health System, Danville, PA.