At the West Cancer Center and Research Institute (WCCRI) from January 2020 to February 2021, patients of African origin (AO) had a 46% increase emergency department (ED) utilization in the Midsouth for pain complaints compared to European origin (EO) resulting in poor patient satisfaction and increased resource utilization. We initiated a quality improvement project with the primary aim to decrease the disparity of ED utilization for patients of AO descent by 25%.


We analyzed ED utilization and associated insurance coverage data for Methodist Le Bonheur Healthcare, TN Connect, and WCCRI’s EMR to assess demographics of patients utilizing the ED for pain control. We interviewed 100 individuals to determine possible causes of noted disparity. We designed a feasibility study and enrolled 30 patients with moderate to severe pain complaints on an in-clinic PRO survey to determine if early intervention would reduce ED utilization.


Underinsured or uninsured patients (EO + AO) were more highly represented in ED visits for pain compared to WCCRI general population, 55% vs 28. Survey participants felt that a lack of dependable clinic access 48% (28%, no same day visit options and 19%, inability to contact treatment team) was the primary factor. Lack of insurance was the next frequently reported reason (22%). Importantly, 50% of AO patients vs 35% EO patients visiting ED for pain reported a moderate to severe pain score on last PRO in-clinic survey.


Access to WCCRI is the primary driver of ED usage for pain complaints in early breast cancer patients. AO patients reported higher pain complaints, are also most likely to lack appropriate insurance coverage, and were more highly represented in this ED population. The use of an in-clinic PRO survey is an effective tool for identifying a population of patients likely to utilize ED for pain control.