Explanatory sequential mixed-methods comparison of oncology hospitalist vs general hospitalist teams for unplanned oncology patient admissions.

487 Background: Hospitalist teams that solely focus on patients with cancer are growing at Comprehensive Cancer Centers. Information on these teams’ patient outcomes, team characteristics, or team processes compared to general hospitalist (GH) teams is scant. Methods: We identified a patient’s first unplanned inpatient admission to either the GH or oncology hospitalist (OH) service at our academic medical center from November 2018-December 2022. We then used propensity-score matching (age, sex, race, metastatic cancer) to balance characteristics between patients seen by GH and OH teams. The primary exposure of interest was the team (GH vs. OH). Primary outcomes were outpatient oncology follow-up within 10 days of discharge, 30-day readmission, and discharge to hospice. We assessed associations using multivariable logistic regression, adjusted for age, race, and comorbidities (Elixhauser). Guided by Verhoven’s Multiteam System of Cancer Care Framework and our quantitative findings, we conducted semi-structured follow-up interviews with OH (n=6), GH (n=7), and oncology consult team (n=2) providers to understand team workflows and differences in patient outcomes. Themes were identified through rapid qualitative analysis and consensus discussions between two qualitative analysts. Results: Our matched sample included 1,082 GH and 361 OH admissions. Median length of stay was 5 days (IQR 3,8) for GH and 6 days for OH (IQR 4, 10) (p <0.01). GH discharged fewer patients to hospice (3% GH vs. 11% OH, p<0.01), but OH had a higher readmission rate (29% vs. 22% GH, p<0.05), and more outpatient oncology follow-up within 10 days (42% vs. 17% GH, p<0.001). In adjusted models, OH had higher odds of discharge to hospice (aOR: 2.2, 95%CI: 1.3-3.9), higher odds of outpatient oncology follow-up (aOR: 4.3, 95%CI: 3.3-5.7), but also higher odds of 30-day readmission (aOR: 1.6, 95%CI: 1.2-2.2) compared to GH. OH sent discharge summaries to outpatient oncologists with follow up recommendations, while GH relied on the consulting oncology team for communication with outpatient oncologists. Other qualitative themes included the value of synchronous communication (i.e., in-person or phone) and co-location in team workrooms with the oncology consult team. Conclusions: Actionable discharge summaries and direct communication with the outpatient oncologist may contribute to more comprehensive and effective discharge planning in patients hospitalized with cancer. Inpatient teams can use these strategies to help improve hospital transitions of care for patients with cancer.