{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:32:37Z","timestamp":1786354357607,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA282242"],"award-info":[{"award-number":["R01CA282242"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Texas Health Resources Clinical Scholars Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medicare\u2019s OP-35 measure (the 35th hospital outpatient quality measure) tracks unplanned hospital visits within 30\u2009days of chemotherapy and defines a subset as \u201cpotentially avoidable\u201d using approximately 300 diagnosis codes. Despite widespread adoption in policy and oncology quality reporting, the measure has not been validated with clinician review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified 14\u2009220 acute hospital visits within 30\u2009days of chemotherapy (2016-2023) from 22 hospitals in 3 health systems (academic, safety-net, community). A 5% stratified random sample of 705 visits underwent blinded review by 3 clinicians, who adjudicated avoidability and assigned a clinical classification for each visit (eg, nonemergent care occurring overnight, nonurgent blood product transfusion, uncontrolled symptoms requiring hospital care). The gold standard definition for an avoidable visit was based on a majority of the clinicians. We assessed the diagnostic characteristics of OP-35 using sensitivity, specificity, accuracy, and area under receiver operator curve (AUROC). We used the clinical classifications to develop a new set of Actionable Categories of avoidability and assessed its diagnostic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinicians judged 30.2% (213\/705) of visits as avoidable. OP-35 classified a similar proportion (30.8%, 217\/705), but agreement was low. Sensitivity of OP-35 was 34.7% (95% confidence interval [CI] = 28.2% to 41.6%), specificity 70.9% (95% CI = 66.7% to 74.8%), and accuracy 59.9% (95% CI = 56.2% to 63.6%), with AUROC of 0.53. The Actionable Categories classification performed better: sensitivity 89.7%, specificity 85.2%, accuracy 86.5%, and AUROC 0.87.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OP-35 showed poor agreement with clinicians for avoidable hospital visits, raising concerns about its clinical validity. An alternative classification system grouping visits into actionable clinical scenarios offered superior diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag081","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T04:39:32Z","timestamp":1773981572000},"page":"1461-1468","source":"Crossref","is-referenced-by-count":0,"title":["Clinician validation of the Medicare measure for potentially avoidable hospital visits after chemotherapies"],"prefix":"10.1093","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6516-6819","authenticated-orcid":false,"given":"Arthur S","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"Peter J. O\u2019Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"Cancer Center, Parkland Health , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9169-4334","authenticated-orcid":false,"given":"Michael D","family":"Dang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4047-3715","authenticated-orcid":false,"given":"Vincent","family":"Merrill","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5166-8211","authenticated-orcid":false,"given":"Liyang","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Joseph","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2655-0616","authenticated-orcid":false,"given":"Sadaf","family":"Charania","sequence":"additional","affiliation":[{"name":"Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"Department of Internal Medicine, University of California San Diego , San Diego, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2624-6724","authenticated-orcid":false,"given":"Lauren L","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"Department of Internal Medicine, Washington University , St. Louis, MO,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela F","family":"Bazzell","sequence":"additional","affiliation":[{"name":"Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5109-3396","authenticated-orcid":false,"given":"Aman","family":"Narayan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7442-2351","authenticated-orcid":false,"given":"Usamah N","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6890-9403","authenticated-orcid":false,"given":"Samar","family":"Bhat","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"De La Porte","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Texas Health Resources , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nkoyo","family":"Effiom","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Texas Health Resources , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Texas Health Resources , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8925-4201","authenticated-orcid":false,"given":"Pranathi","family":"Pilla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"School of Medicine, Baylor College of Medicine , Houston, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Mark","family":"Courtney","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7786-8786","authenticated-orcid":false,"given":"Navid","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas, TX,","place":["United States"]},{"name":"Cancer Center, Parkland Health , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3042-2741","authenticated-orcid":false,"given":"Ethan A","family":"Halm","sequence":"additional","affiliation":[{"name":"Department of Medicine, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"2026081005025442700_djag081-B1","author":"Centers for Medicare & Medicaid Services"},{"key":"2026081005025442700_djag081-B2","author":"Centers for Medicare & Medicaid Services"},{"key":"2026081005025442700_djag081-B3","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1002\/onco.13681","article-title":"Emergency department visits for emesis following chemotherapy: guideline nonadherence, OP-35, and a path back to the future","volume":"26","author":"Neugut","year":"2021","journal-title":"Oncologist"},{"key":"2026081005025442700_djag081-B4","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1002\/onco.13620","article-title":"Avoidable acute care use associated with nausea and vomiting among patients receiving highly emetogenic chemotherapy or oxaliplatin","volume":"26","author":"Navari","year":"2021","journal-title":"Oncologist"},{"key":"2026081005025442700_djag081-B5","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1200\/OP.24.00160","article-title":"Assessing the validity of the centers for Medicare & Medicaid services measure in identifying potentially preventable emergency department visits by patients with cancer","volume":"21","author":"Alishahi Tabriz","year":"2025","journal-title":"JCO Oncol Pract"},{"key":"2026081005025442700_djag081-B6","doi-asserted-by":"publisher","first-page":"e2250423","DOI":"10.1001\/jamanetworkopen.2022.50423","article-title":"Trends and characteristics of potentially preventable emergency department visits among patients with cancer in the US","volume":"6","author":"Alishahi Tabriz","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026081005025442700_djag081-B7","doi-asserted-by":"publisher","first-page":"e176","DOI":"10.1200\/JOP.2017.028191","article-title":"Characterizing potentially preventable cancer- and chronic disease\u2013related emergency department use in the year after treatment initiation: a regional study","volume":"14","author":"Panattoni","year":"2018","journal-title":"J Oncol Pract"},{"key":"2026081005025442700_djag081-B8","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1200\/OP.2025.21.10_suppl.421","article-title":"Performance characteristics of CMS\u2019 OP-35 quality measure: sensitive but not specific","volume":"21","author":"Huey","year":"2025","journal-title":"JCO Oncol Pract"},{"key":"2026081005025442700_djag081-B9","doi-asserted-by":"publisher","first-page":"e1738","DOI":"10.1200\/OP.20.00889","article-title":"Prior frequent emergency department use as a predictor of emergency department visits after a new cancer diagnosis","volume":"17","author":"Hong","year":"2021","journal-title":"JCO Oncol Pract"},{"key":"2026081005025442700_djag081-B10","doi-asserted-by":"crossref","first-page":"e501","DOI":"10.1200\/JOP.18.00743","article-title":"Impact of a cancer urgent care clinic on regional emergency department visits","volume":"15","author":"Hong","year":"2019","journal-title":"J Oncol Pract"},{"key":"2026081005025442700_djag081-B11","doi-asserted-by":"publisher","first-page":"e490","DOI":"10.1200\/JOP.18.00614","article-title":"Characteristics of emergency department visits and select predictors of hospitalization for adults with newly-diagnosed cancer in a safety-net health system","volume":"15","author":"Hong","year":"2019","journal-title":"J Oncol Pract"},{"key":"2026081005025442700_djag081-B12","year":"2023"},{"key":"2026081005025442700_djag081-B13","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/s0196-0644(96)70264-0","article-title":"Chart reviews in emergency medicine research: where are the methods?","volume":"27","author":"Gilbert","year":"1996","journal-title":"Ann Emerg Med"},{"key":"2026081005025442700_djag081-B14","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1001\/archinternmed.2009.333","article-title":"Diagnostic error in medicine: analysis of 583 physician-reported errors","volume":"169","author":"Schiff","year":"2009","journal-title":"Arch Intern Med"},{"key":"2026081005025442700_djag081-B15","article-title":"Emergency department visits for nonurgent conditions: systematic literature review","author":"Uscher-Pines","year":"2013","journal-title":"Am J"},{"key":"2026081005025442700_djag081-B16","doi-asserted-by":"publisher","first-page":"e564","DOI":"10.1200\/OP.20.00617","article-title":"Patterns and results of triage advice before emergency department visits made by patients with cancer","volume":"17","author":"Hong","year":"2021","journal-title":"JCO Oncol Pract"},{"key":"2026081005025442700_djag081-B17","doi-asserted-by":"publisher","first-page":"e312","DOI":"10.37765\/ajmc.2024.89628","article-title":"How English- and Spanish-preferring patients with cancer decide on emergency care","volume":"30","author":"Hong","year":"2024","journal-title":"Am J Manag Care"},{"key":"2026081005025442700_djag081-B18","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1007\/s00520-025-09469-8","article-title":"Multidisciplinary clinician perspectives on avoidable emergency department use by patients during cancer treatment","volume":"33","author":"Hong","year":"2025","journal-title":"Support Care Cancer"},{"key":"2026081005025442700_djag081-B19","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1200\/JOP","article-title":"Best practices for reducing unplanned acute care for patients with cancer","volume":"14","author":"Handley","year":"2018","journal-title":"J Oncol Pract"},{"key":"2026081005025442700_djag081-B20","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s44201-022-00005-6","article-title":"Cancer-related emergency and urgent care: expanding the research agenda","volume":"1","author":"Shelburne","year":"2022","journal-title":"Emerg Cancer Care"},{"key":"2026081005025442700_djag081-B21","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1001\/jamaoncol.2014.155","article-title":"Clinician perspectives on potentially avoidable hospitalizations in patients with cancer","volume":"1","author":"Brooks","year":"2015","journal-title":"JAMA Oncol"},{"key":"2026081005025442700_djag081-B22","doi-asserted-by":"publisher","first-page":"e2500297","DOI":"10.1200\/CCI-25-00297","article-title":"Dissonance in the sole quality measure for outpatient chemotherapy, OP-35","volume":"9","author":"Akula","year":"2025","journal-title":"JCO Clin Cancer Inform."},{"key":"2026081005025442700_djag081-B23","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1111\/1475-6773.13114","article-title":"Linkage between Utah all payers claims database and central cancer registry","volume":"54","author":"Garvin","year":"2019","journal-title":"Health Serv Res"},{"key":"2026081005025442700_djag081-B24","volume-title":"Texas All-Payor Claims Database Biennial Report to the 88th Legislature","author":"Center for Health Care Data UHSoPH","year":"2022"},{"key":"2026081005025442700_djag081-B25","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1258\/135581907781543012","article-title":"Inter-rater reliability of case-note audit: a systematic review","volume":"12","author":"Lilford","year":"2007","journal-title":"J Health Serv Res Policy"},{"key":"2026081005025442700_djag081-B26","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12911-017-0487-4","article-title":"ACSC indicator: testing reliability for hypertension","volume":"17","author":"Walker","year":"2017","journal-title":"BMC Med Inform Decis Mak"}],"container-title":["JNCI: Journal of the National Cancer Institute"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djag081\/67421243\/djag081.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/118\/8\/1461\/67421243\/djag081.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/118\/8\/1461\/67421243\/djag081.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:02:59Z","timestamp":1786352579000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jnci\/article\/118\/8\/1461\/8529440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,3,19]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jnci\/djag081","relation":{},"ISSN":["0027-8874","1460-2105"],"issn-type":[{"value":"0027-8874","type":"print"},{"value":"1460-2105","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,3,19]]}}}