Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits

PURPOSE: Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer? PATIENTS AND METHODS: We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group. Our primary outcome was emergency department visits within 180 days after a cancer diagnosis, compiled as adjusted monthly rates of emergency department visits per 1,000 patient-months. We analyzed subsequent hospitalizations as a secondary outcome. RESULTS: The rate of weekday emergency department visits was increasing at a rate of 0.43 visits (95% CI, 0.29 to 0.57 visits) per month before May 2012, then fell in half to a rate of 0.19 visits (95% CI, 0.11 to 0.28 visits) per month (P = .007) after the urgent care clinic was established. In contrast, the weekend visit rate was growing at a rate of 0.08 visits (95% CI, -0.03 to 0.19 visits) per month before May 2012 and 0.05 (95% CI, -0.02 to 0.13 visits; P = .533) afterward. By the end of 2016, there were 15.3 fewer monthly weekday emergency department visits than expected (P = .005). Trends in weekday hospitalizations were not significantly changed. CONCLUSION: Although only one in eight emergency department-visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.