Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

May 9, 2019

How can we get better outcomes for our patients? Research.

By Elizabeth Zimmermann

In the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, every project is inspired by real-world challenges experienced by patients at Mayo Clinic and elsewhere. Together with Mayo Clinic's health care providers, center experts research ways to improve outcomes for patients across all of medicine, from Alzheimer's disease to cancer and beyond.

Illustration of liver, bile ducts, gall bladder, stomach

Illustration of liver, bile ducts, gall bladder, stomach

"When" matters, for chemotherapy

In a research study published in March 2019 in the European Journal of Surgical Oncology, a center team reported on its investigation into whether patients should receive chemotherapy before or after surgery to remove cholangiocarcinoma (cancer in the bile ducts).

Chemotherapy is often used in treating cholangiocarcinoma, but until this study, no one could say for certain whether there was any benefit to receiving chemotherapy before, as opposed to after surgery.

Using the National Cancer Database, the team looked at the records of 1,450 patients who received both surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and 2014. They found that about 21% of the patients received chemotherapy before surgery. However, they found that patients who received chemotherapy before surgery lived on average 7.5 months longer than those who received it after surgery (median overall survival 40.3 versus 32.8 months).

These findings will assist physicians to develop treatment plans resulting in the best possible outcomes for their patients. They also will affect future research, as the paper's authors state, "Our findings have implications in designing future clinical trials."

Cholangiocarcinoma is associated with poor prognosis, and there is limited data on how best to treat this disease. This study provides preliminary data for benefit of chemotherapy prior to surgery, and currently Mayo Clinic is participating in a clinical trial evaluating the potential effectiveness of a combination of chemotherapy drugs given prior to surgery.

Keeping people out of the hospital

With a similar goal of achieving the best possible outcomes for patients, another team of researchers quantified the risk of readmission to the hospital within 30 days, specifically when discharged to a skilled nursing facility. Their findings were published in the Journal of the American Medical Directors Association.

Repeated hospitalizations can be harmful, especially for elderly patients. 30-day readmissions are a widely accepted measurement of hospital quality, and something that health care providers continuously strive to minimize. The researchers evaluated the records of 6,032 patients, age 55 or older, discharged to a skilled nursing facility between January 1, 2009, and June 30, 2014.

Across the group, there were 8,616 discharges to skilled nursing facilities. Of these, 1,568 needed readmittance to the hospital within 30 days.

They found some significant predictors of readmittance:

  • Prolonged initial hospital stays
  • Need for ICU-level care in the initial hospitalization
  • Abnormal levels of laboratory parameters such as hemoglobin, creatinine, sodium and potassium before discharge

Additionally, medically complex patients – with multiple chronic conditions or a complex medical situation – were more likely to be readmitted, along with those who had needed frequent emergency department visits and/or hospitalizations in the preceding 6 months.

Armed with this information, they created a prediction tool to identify patients who are most likely to end up back in the hospital – for any reason. This tool can help both hospitals and skilled nursing facilities identify individuals at greater risk of readmission, who may then be prioritized for greater clinical monitoring and targeted interventions.

At Mayo Clinic research drives everything we do for patients. The Mayo Clinic Kern Center for the Science of Health Care Delivery in particular works with Mayo's medical practice to continuously reimagine and improve the way we collect, store, analyze and use health and disease information. These studies are two examples of the kinds of contributions health care delivery research brings to bear as we build the evidence base for best practices and personalized care.


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Tags: bile ducts, cancer, care transitions, Center for the Science of Health Care Delivery, ICU, intensive care unit, Mayo Clinic Cancer Center, multiple chronic conditions, News, readmissions, surgery

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