The frequency and time point of outpatient palliative care integration for people before death: an analysis of health insurance data in Lower Saxony, Germany

Abstract Aim This study aimed to analyse the number of deceased people who received different types of outpatient palliative care, the length of time prior to death that care was initiated, and their palliative care trajectory including the rate of hospital death. Subject and methods Data on 35,514 adults insured by the statutory health insurance who died in 2017 in Lower Saxony, Germany, were analysed. The study examined the provision of three different types of outpatient palliative care: general (GPC), intermediate (IPC) and specialised palliative care (SPC). In addition, oncological palliative care services (OS) were considered. Descriptive analyses include frequencies, timing and duration of these services, the number of inpatient hospital stays and hospital deaths. Results Prior to death, 31.4% of the deceased received outpatient palliative care: 21.3% GPC, 6.4% GPC with IPC and/or SPC and/or OS; and 3.7% IPC and/or SPC and/or OS, but no GPC. On average, GPC and OS were initiated 9 months and SPC 3 months prior to death. Six percent of the analytic sample received outpatient palliative care more than 2 years before death. Compared to those without outpatient palliative care, patients who received outpatient palliative care had more and longer inpatient hospital stays, but less frequently died in hospital. Conclusion Early outpatient palliative care took place in a minor percentage of deceased. Outpatient palliative care starts late before death for most patients, but enables more people not to die in hospital. However, significantly fewer people receive outpatient palliative care relative to current demand estimates. This is particularly true of general outpatient palliative care.

Download Full-text

Ethnic Disparities in AL Amyloidosis Outcomes Among Hospitalized Patients in the United States

Blood ◽

10.1182/blood-2021-147060 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4110-4110

Author(s):

Samer Al Hadidi ◽

Deepa Dongarwar ◽

Hamisu Salihu ◽

Carolina Schinke ◽

Sharmilan Thanendrarajan ◽

...

Keyword(s):

Palliative Care ◽

Health Disparities ◽

Hospital Mortality ◽

Conflicts Of Interest ◽

The United States ◽

Hospital Death ◽

Al Amyloidosis ◽

Type I ◽

Care Services ◽

Palliative Care Services

Abstract INTRODUCTION Health disparities in immunoglobulin light chain (AL) amyloidosis have not been well described. We aimed to assess if health disparities between non-Hispanic (NH)-Whites, NH-Blacks and Hispanics exist and to describe differences between different ethnic/racial groups. METHODS We conducted a retrospective cross-sectional analysis of in-patient AL amyloidosis hospitalizations from 2016 to 2018 using the Nationwide Inpatient Sample (NIS), a database which provides nationally representative information on hospitalizations in the U.S. The studied period was chosen to capture data from the ICD-10-CM codes to avoid misclassification of AL amyloidosis which was grouped with other cases of ATTR amyloidosis in the ICD-9-CM coding system. All hospitalizations in adults (age ≥18 years) were included. The exposure for the study was the occurrence of AL amyloidosis in the discharge records. Outcomes were [1] in-hospital death [2] chemotherapy use; [3] intensive care unit (ICU) utilization; [4] palliative care consultation. The analysis for this study was performed using R program version 3.5.1; a 5% type I error rate for all hypothesis tests (two-sided) was assumed. RESULTS Admissions related to AL amyloidosis constituted 0.03% of all hospitalizations in the study period (25,470 of 90,869,381). The prevalence of AL amyloidosis related hospitalizations was higher in NH-Blacks when compared with NH-Whites (42.8 vs.28.1 per 100,000 hospitalizations). AL amyloidosis related in-hospital mortality rate was higher in NH-Whites and Hispanics when compared to NH-Blacks (6.6%% and 6.2% vs. 4.9%). In-hospital mortality with AL amyloidosis was higher in older patients, males and those who self-paid for their treatment. Utilization of ICU care was more common in NH-Blacks when compared to NH-Whites (6% vs. 4.8%). Hispanics had the lowest inpatient chemotherapy use (1.7% vs. 2.9%). Multivariable adjusted association between race/ethnicity and various outcomes showed a trend towards lower in-hospital mortality in NH-Blacks when compared to NH-Whites (OR: 0.76, 95% CI: 0.55-1.05, p=0.09) and lower utilization of palliative care services in NH-Blacks when compared with NH-Whites (OR: 0.61, 95% CI: 0.42-0.88, p=0.01). Despite very low numbers of transplant related admissions, such admissions occurred only in NH-Whites. CONCLUSIONS Our findings highlight disparities in AL amyloidosis care for NH-Blacks and Hispanics. NH-Blacks tend to have lower in-hospital mortality with higher utilization of ICU care, nevertheless, they receive the lowest palliative care services. Despite the higher utilization of ICU care, data suggest possible superior outcomes of AL amyloidosis in NH-Blacks when compared to NH-Whites. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Effectiveness of palliative care services: A population-based study of end-of-life care for cancer patients

Palliative Medicine ◽

10.1177/0269216318778729 ◽

2018 ◽

Vol 32 (8) ◽

pp. 1344-1352 ◽

Cited By ~ 6

Author(s):

Rossana De Palma ◽

Daniela Fortuna ◽

Sarah E Hegarty ◽

Daniel Z Louis ◽

Rita Maria Melotti ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Conditional Logistic Regression ◽

Emergency Department Visits ◽

Administrative Databases ◽

Hospital Death ◽

Care Services ◽

Palliative Care Services ◽

The Impact

Background: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. Aim: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. Design: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model. Setting/participants: The study was conducted on the cohort of 34,357 patients, resident in Emilia-Romagna Region, Italy, admitted to hospital with a diagnosis of metastatic or poor-prognosis cancer during the 6 months before death between January 2013 and December 2015. Results: Patients who received palliative care experienced significantly lower rates of all indicators of aggressive care such as hospital admission (odds ratio (OR) = 0.05, 95% confidence interval (CI): 0.04–0.06), emergency department visits (OR = 0.23, 95% CI: 0.21–0.25), intensive care unit stays (OR = 0.29, 95% CI: 0.26–0.32), major operating room procedures (OR = 0.22, 95% CI: 0.21–0.24), and lower in-hospital death (OR = 0.11, 95% CI: 0.10–0.11). This cohort had significantly higher rates of opiate prescriptions (OR = 1.27, 95% CI: 1.21–1.33) ( p < 0.01 for all comparisons). Conclusion: Use of palliative care at the end of life for cancer patients is associated with a reduction of the use of high-cost, intensive services. Future research is necessary to evaluate the impact of increasing use of palliative care services on other health outcomes. Administrative databases linked at the patient level are a useful data source for assessment of care at the end of life.

Download Full-text

Inpatient Palliative Care Is Less Utilized in Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910004 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10004

Author(s):

Zahra Mojtahedi ◽

Ji Won Yoo ◽

Karen Callahan ◽

Neeraj Bhandari ◽

Donghui Lou ◽

...

Keyword(s):

Palliative Care ◽

Hospital Admissions ◽

Severe Disease ◽

Female Gender ◽

Hospital Charges ◽

Care Utilization ◽

Hospital Death ◽

Extrahepatic Cholangiocarcinoma ◽

Hospital Patients ◽

Palliative Care Services

Background—Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives—To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical characteristics, hospital charges, and LOS. Methods—De-identified patient data of each hospitalization were retrieved from the National Inpatient Sample (NIS) database. Codes V66.7 (ICD-9-CM) or Z51.5 (ICD-10-CM) were used to find palliative care utilization. Multivariate adjusted logistic regression analyses were conducted to assess factors associated with palliative care use, LOS, hospital charges, and in-hospital death. Results—Of 4426 hospitalizations, only 6.7% received palliative care services. Palliative care utilization did not significantly increase over time (p = 0.06); it reduced hospital charges by USD 25,937 (p < 0.0001) and LOS by 1.3 days (p = 0.0004) per hospitalization. Palliative care was positively associated with female gender, severe disease, and age group ≥80 (p ≤ 0.05). The average LOS was 8.5 days for each admission. Conclusions—Hospital admissions with palliative care utilization had lower hospital charges and LOS in ECC. However, ECC patients received less palliative care compared with more common cancers sharing similar symptoms (e.g., pancreatic cancer). ECC patients also had longer LOS compared with the national average. Further research is warranted to develop interventions to increase palliative care utilization among ECC hospital patients.

Download Full-text

Validation of the responding to urgency of need in palliative care (RUN-PC) triage tool

Palliative Medicine ◽

10.1177/0269216320986730 ◽

2021 ◽

pp. 026921632098673

Author(s):

Bethany Russell ◽

Jennifer Philip ◽

Olivia Wawryk ◽

Sara Vogrin ◽

Jodie Burchell ◽

...

Keyword(s):

Palliative Care ◽

Convergent Validity ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Reference Standard ◽

Rater Reliability ◽

Care Experience ◽

Inpatient Hospital ◽

Care Services ◽

Palliative Care Services

Background: The Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool is a novel, evidence-based tool by which specialist palliative care services can manage waiting lists and workflow by prioritising access to care for those patients with the most pressing needs in an equitable, efficient and transparent manner. Aim: This study aimed to establish the intra- and inter-rater reliability, and convergent validity of the RUN-PC Triage Tool and generate recommended response times. Design: An online survey of palliative care intake officers applying the RUN-PC Triage Tool to a series of 49 real clinical vignettes was assessed against a reference standard: a postal survey of expert palliative care clinicians ranking the same vignettes in order of urgency. Setting/Participants: Intake officers ( n = 28) with a minimum of 2 years palliative care experience and expert clinicians ( n = 32) with a minimum of 10 years palliative care experience were recruited from inpatient, hospital consultation and community palliative care services across metropolitan and regional Victoria, Australia. Results: The RUN-PC Triage Tool has good intra- and inter-rater reliability in inpatient, hospital consultation and community palliative care settings (Intraclass Correlation Coefficients ranged from 0.61 to 0.74), and moderate to good correlation to expert opinion used as a reference standard (Kendall’s Tau rank correlation coefficients ranged from 0.68 to 0.83). Conclusion: The RUN-PC Triage Tool appears to be a reliable and valid tool for the prioritisation of patients referred to specialist inpatient, hospital consultation and community palliative care services.

Download Full-text