Abstract 14583: Palliative Care Services in Patients Admitted With Cardiogenic Shock in the United States: Frequency and Predictors of 30-day Readmission

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zekun Feng ◽  
Boback Ziaeian ◽  
Gregg C Fonarow
Keyword(s):  
Palliative Care ◽  
Cardiogenic Shock ◽  
The United States ◽  
Left Ventricular ◽  
Renal Diseases ◽  
Readmission Rates ◽  
Care Services ◽  
Icd 10 ◽  
Palliative Care Services ◽  
Dnr Orders

Introduction: Patients admitted with cardiogenic shock (CS) have high in-patient mortality and readmission rates. Palliative care services (PCS) may be underutilized in this population and the association with 30-day readmission and other predictive factors are unknown. Methods: Using the 2017 Healthcare Cost and Utilization Project’s National Readmission Database, we identified index admissions in patients with (1) CS (ICD-10-CM code R57.0) and (2) CS with PCS (ICD-10-CM code Z51.5). Patients with orthotopic heart transplant or left ventricular assist device were excluded. We compared differences in 30-day readmission outcomes and identified readmission predictors using logistic regression analysis. Results: Among 127,045 survey-weighted CS index admissions, inpatient mortality was 37.0%. In those survived (n=80,030), 21.0% (n=16,779) were readmitted within 30 days and 12.3% (n=9,841) had DNR orders (ICD-10-CM code Z66). Of 26,555 CS with PCS index admissions, 72.5% died inpatient. In those survived (n=7,285), 11.6% (n=844) were readmitted within 30 days and 61.2% (n=4,461) had DNR orders. From CS with PCS index admissions, mean age was 70.7; 39.2% were female; 50.0% discharged to skilled nursing facility and 33.9% discharged to home health care. The average time to readmission was 11.8 days with 36% of all readmissions within first 14 days. Primary causes of readmission were cardiac (47.7%) and infectious (13.7%). Predictors of 30-day readmission for CS group versus CS with PCS group are listed in table. Conclusions: Use of PCS in patient admitted with CS remains low at 8.6% in 2017. PCS and DNR orders were associated with lower risk of 30-day readmission. Those receiving PCS during index admission had lower readmission rates at 11.6%. In CS with PCS index admissions, cardiopulmonary and renal diseases were positive predictors while female gender, private insurance, private hospital and higher household income were negative predictors of 30-day readmission.

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

Blood ◽  
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.

scholarly journals Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States

2020 ◽  
Vol 34 (4) ◽  
pp. 513-523 ◽  
Author(s):  
Deokhee Yi ◽  
Bridget M Johnston ◽  
Karen Ryan ◽  
Barbara A Daveson ◽  
Diane E Meier ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
Home Care ◽  
Service Use ◽  
The United States ◽  
Care Services ◽  
Health And Social Care ◽  
Total Care ◽  
Palliative Care Services ◽  
Care Costs

Background: Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. Aim: The aim of this study was to compare health and social care costs, quality and their drivers in the last 3 months of life for older adults across countries. Null hypothesis: no difference between countries. Design: Mortality follow-back survey. Costs were calculated from carers’ reported service use and unit costs. Setting: Palliative care services in England (London), Ireland (Dublin) and the United States (New York, San Francisco). Participants: Informal carers of decedents who had received palliative care participated in the study. Results: A total of 767 questionnaires were returned: 245 in England, 282 in Ireland and 240 in the United States. Mean care costs per person with cancer/non-cancer were US$37,250/US$37,376 (the United States), US$29,065/US$29,411 (Ireland), US$15,347/US$16,631 (England) and differed significantly ( F = 25.79/14.27, p < 0.000). Cost distributions differed and were most homogeneous in England. In all countries, hospital care accounted for > 80% of total care costs; community care 6%–16%, palliative care 1%–15%; 10% of decedents used ~30% of total care costs. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction. Conclusion: Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the United States were high and highly variable, suggesting that high-cost low-value care may be prevalent.

The Snog and Grog Club

2012 ◽  
Vol 23 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Allison Kabel
Keyword(s):  
Palliative Care ◽  
Health Professionals ◽  
Day Care ◽  
The United States ◽  
Care Staff ◽  
Staff Members ◽  
Care Services ◽  
Life Threatening Illness ◽  
Palliative Care Services ◽  
End Stage

The popularity of British hospice day care signals the expanding boundaries of palliative care beyond end-stage illness. In this article, I examine the ways hospice philosophy was interpreted and implemented in an outpatient day therapy setting run by a multidisciplinary team of health professionals. Findings suggest that hospice day care staff members used several strategies to help patients cope and retain a sense of personhood while facing numerous emotional and physical challenges associated with life-threatening illness. Health professionals in the United States will need to prepare for patients accessing hospice and palliative care services earlier in the illness trajectory to take advantage of these opportunities for patient support and advocacy.

Palliative care and aggressive interventions after falling: A Nationwide Inpatient Sample analysis

2021 ◽  
pp. 1-6
Author(s):  
Vanessa P. Ho ◽  
Wyatt P. Bensken ◽  
Siran M. Koroukian
Keyword(s):  
Palliative Care ◽  
Nationwide Inpatient Sample ◽  
Feeding Tube ◽  
Tube Placement ◽  
Discharge Data ◽  
Future Goals ◽  
Care Services ◽  
Icd 10 ◽  
Palliative Care Services ◽  
Aggressive Interventions

Abstract Objective The purpose of this study is to identify whether there is an opportunity for improvement to provide palliative care services after a serious fall. We hypothesized that (1) palliative care services would be utilized in less than 10% of patients over the age of 65 who fall and (2) more than 20% of patients would receive aggressive life-sustaining treatments (LSTs) prior to death. Methods Using the 2017 Nationwide Inpatient Sample, we identified patients who were admitted to the hospital with a fall (ICD-10 W00-W19) and were hospitalized at least two days with valid discharge data. Palliative care services (Z51.5) or LSTs (cardiopulmonary resuscitation, ventilation, reintubation, tracheostomy, feeding tube placement, vasopressors, transfusion, total parenteral nutrition, and hemodialysis) were identified with ICD-10 codes. We examined the use of palliative care or LSTs by discharge destination (home, facility, and death). Logistic regression was used to identify factors associated with palliative care. Results In total, 155,241 patients were identified (median 82 years old, interquartile range 74–88); 2.5% died in hospital, and 69.4% were transferred to a facility. Palliative care occurred in 4.5% of patients, and LST occurred in 15.1%. Patients who died were significantly more likely to have had palliative care (50.1% vs. 3.4% of home or facility discharges) and were more likely to have an LST [53.0% vs. 9.8% (home) vs. 15.9% (facility)]. Palliative care was associated with both death [adjusted odds ratio (AOR) 19.84, 95% confidence interval (CI) 18.39–21.41, p < 0.001] and LST (AOR 1.36, 95% CI 1.27–1.46, p < 0.001). Significance of results Palliative care is associated with both death and LST, suggesting that physicians use palliative care as a last resort after aggressive measures have been exhausted. Patients who fall would likely benefit from the early use of palliative care to align future goals of care.

Microethical & Relational Insights from Pediatric Palliative Care

2020 ◽  
Vol 7 (4) ◽  
pp. 94-96
Author(s):  
Dr. Abhijit Shinde ◽  
Dr. Sunil Natha Mhaske ◽  
Dr. Ramesh Kothari ◽  
Dr. Sonal Shinde
Keyword(s):  
United States ◽  
Palliative Care ◽  
End Of Life ◽  
The United States ◽  
Pediatric Palliative Care ◽  
Live Births ◽  
Care Services ◽  
Palliative Care Services ◽  
Life Threatening ◽  
Developed World

In the India, more than 30 per 1000 live births of infants die each year before, during, or after birth as do many children with life- limiting conditions. In most countries in the developed world including the United States, the vast majority of infants, children and teenagers at end of life do not have access to multidisciplinary pediatric palliative care services in their community or at a children’shospital. Pediatric palliative care is for children and teenagers suffering from life- threatening or life-limiting conditions in which survival into adulthood is or may be jeopardized if curative treatments  fail. As a result, pediatric palliative care may last over many years.

Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies

2020 ◽  
pp. 104990912092277
Author(s):  
Kimberley Lee ◽  
Faiz Gani ◽  
Joseph K. Canner ◽  
Fabian M. Johnston
Keyword(s):  
Palliative Care ◽  
Racial Disparities ◽  
Advanced Cancer ◽  
The United States ◽  
Patients With Cancer ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Black Patients ◽  
Palliative Care Services ◽  
Care Consultation

Background: There is increasing recognition of the importance of early incorporation of palliative care services in the care of patients with advanced cancers. Hospice-based palliative care remains underutilized for black patients with cancer, and there is limited literature on racial disparities in use of non-hospice-based palliative care services for patients with cancer. Objective: The primary objective of this study is to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Design: This retrospective cohort study analyzed 204 175 hospital admissions of patients with advanced cancers between 2012 and 2014. The cohort was identified through the National Inpatient Dataset. International Classification of Disease, Ninth Revision codes were used to identify receipt of a palliative care consultation. Results: Of this, 57.7% of those who died received IPCC compared to 10.5% who were discharged alive. In multivariable logistic regression models, black patients discharged from the hospital, were significantly less likely to receive a palliative care consult compared to white patients (odds ratio [OR] black: 0.69, 95% CI: 0.62-0.76). Conclusions: Death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There are significant racial disparities in the utilization of IPCC for patients with advanced cancer.

Differences between incarcerated and non-incarcerated patients who die in community hospitals highlight the need for palliative care services for seriously ill prisoners in correctional facilities and in community hospitals: A cross-sectional study

2017 ◽  
Vol 32 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Alex Rothman ◽  
Shannon McConville ◽  
Renee Hsia ◽  
Lia Metzger ◽  
Cyrus Ahalt ◽  
...  
Keyword(s):  
Palliative Care ◽  
The United States ◽  
Cross Sectional Study ◽  
Correctional Facilities ◽  
Sectional Study ◽  
Community Hospitals ◽  
Cross Sectional ◽  
Care Services ◽  
Palliative Care Services ◽  
Seriously Ill

Background: Incarcerated populations worldwide are aging dramatically; in the United States, prisoner mortality rates have reached an all-time high. Little is known about the incarcerated patients who die in community hospitals. Aim: Compare incarcerated and non-incarcerated hospital decedents in California. Design: Cross-sectional study. Setting/participants: All state hospital decedents ( N = 370,831) from 2009 to 2013, decedent age over time examined with additional data (2001–2013). Results: Overall, 745 incarcerated and 370,086 non-incarcerated individuals died in California hospitals. Incarcerated decedents were more often male (93% vs 51%), Black (19% vs 8%) Latino (27% vs 19%), younger (55 vs 73 years), had shorter hospitalizations (13 vs 16 days), and fewer had an advance care plan (23% vs 36%, p < 0.05). Incarcerated decedents had higher rates of cancer, liver disease, HIV/AIDs, and mental health disorders. Cause of death was disproportionately missing for incarcerated decedents. The average age of incarcerated decedents rose between 2001 and 2013, while it remained stable for others. Conclusion: Palliative care services in correctional facilities should accommodate the needs of relatively young patients and those with mental illness. Given the simultaneous growth in the older prisoner population with the rising age of incarcerated hospital decedents, community hospital clinicians should be prepared to care for seriously ill, incarcerated patients. Significant epidemiologic differences between incarcerated and non-incarcerated decedents in this study suggest the importance of examining the differential palliative care needs of incarcerated patients in all communities.

Pharmacist-Delivered Patient Care in an Interdisciplinary Team-Based Institutional Palliative Care Clinic, 2012 to 2018

2019 ◽  
pp. 082585971986961 ◽  
Author(s):  
Lindsey E. Dayer ◽  
Elizabeth R. McDade ◽  
Sarah Harrington
Keyword(s):  
Palliative Care ◽  
Patient Care ◽  
Interprofessional Education ◽  
Palliative Care Service ◽  
Interdisciplinary Team ◽  
The United States ◽  
Care Clinic ◽  
Care Services ◽  
Palliative Care Setting ◽  
Palliative Care Services

Palliative care services offered in the United States have grown substantially since the year 2000. These types of services have been shown to improve a patient’s quality of life when presented with a serious or life-threatening disease or illness. An important characteristic of a quality palliative care service is the presence of an interdisciplinary team to utilize different areas of expertise to address multiple aspects of patient care. An important member of this team is the pharmacist. The services presented in this interprofessional education and practice guide describe pharmacist-delivered palliative care services offered in an institutional ambulatory palliative care setting from 2012 to 2018.

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