Differential Utilization of Palliative Care Consultation Between Medical and Surgical Services

2019 ◽  
Vol 37 (4) ◽  
pp. 250-257 ◽  
Author(s):  
Minh-Thuy Nguyen ◽  
Timothy Feeney ◽  
Chanmin Kim ◽  
F. Thurston Drake ◽  
Suzanne E. Mitchell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Providers ◽  
Medical Center ◽  
Bayesian Regression ◽  
Median Income ◽  
Medical Specialties ◽  
Surgical Services ◽  
Palliative Care Consultation ◽  
Credible Intervals ◽  
Care Consultation

There is a paucity of data regarding the utilization of palliative care consultation (PCC) in surgical specialties. We conducted a retrospective review of 2321 adult patients (age ≥18) who died within 6 months of admission to Boston Medical Center from 2012 to 2017. Patients were included for analysis if their length of stay was more than 48 hours and if, based on their diagnoses as determined by literature review and expert consensus, they would have benefited from PCC. Bayesian regression was used to estimate the odds ratio (OR) and 99% credible intervals (CrI) of receiving PCC adjusted for age, sex, race, insurance status, median income, and comorbidity status. Among the 739 patients who fit the inclusion criteria, only 30% (n = 222) received PCC even though 664 (90%) and 75 (10%) of these patients were identified as warranting PCC on medical and surgical services, respectively. Of the 222 patients who received PCC, 214 (96%) were cared for by medical services and 8 (4%) were cared for by surgical services. Patients cared for primarily by surgical were significantly less likely to receive PCC than primary patients of medical service providers (OR, 0.19, 99% CrI, 0.056-0.48). At our institution, many surgical patients appropriate for PCC are unable to benefit from this service due to low consultation numbers. Further investigation is warranted to examine if this phenomenon is observed at other institutions, elucidate the reasons for this disparity, and develop interventions to increase the appropriate use of PCC throughout all medical specialties.

scholarly journals Navigating Tensions: Integrating Palliative Care Consultation Services Into an Academic Medical Center Setting

2011 ◽  
Vol 42 (5) ◽  
pp. 680-690 ◽  
Author(s):  
Sally A. Norton ◽  
Bethel Ann Powers ◽  
Madeline H. Schmitt ◽  
Maureen Metzger ◽  
Eileen Fairbanks ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Palliative Care Consultation ◽  
Academic Medical ◽  
Care Consultation ◽  
Consultation Services

Patient-Level Factors Influencing Palliative Care Consultation at a Safety-Net Urban Hospital

2020 ◽  
pp. 104990912098176
Author(s):  
Minh-Thuy Nguyen ◽  
Timothy Feeney ◽  
Chanmin Kim ◽  
F. Thurston Drake ◽  
Suzanne E. Mitchell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Safety Net ◽  
Bayesian Regression ◽  
English Speakers ◽  
Insurance Status ◽  
Patient Level ◽  
Income Status ◽  
Factors Influencing ◽  
Palliative Care Consultation ◽  
Care Consultation

The influence of patient-level factors on palliative and hospice care is unclear. We conducted a retrospective review of 2321 patients aged ≥18 that died within 6 months of admission to our institution between 2012 and 2017. Patients were included for analysis if their chart was complete, their length of stay was ≥48 hours, and if based on their diagnoses, they would have benefited from palliative care consultation (PCC). Bayesian regression with a weakly informative prior was used to find the odds ratio (OR) and 99% credible interval (CrI) of receiving PCC based on race/ethnicity, education, language, insurance status, and income. 730 patients fit our inclusion criteria and 30% (n = 211) received PCC. The OR of receiving PCC was 1.26 (99% CrI, 0.73-2.12) for Blacks, 0.81 (99% CrI, 0.31-1.86) for Hispanics, and 0.69 (99% CrI, 0.19-2.46) for other minorities. Less than high school education was associated with greater odds of PCC (OR 2.28, 99% CrI, 1.09-4.93) compared to no schooling. Compared to English speakers, non-English speakers had higher odds of receiving PCC when cared for by medical services (OR 3.01 [99% CrI, 1.44-5.32]) but lower odds of PCC when cared for by surgical services (0.22 [99% CrI, <0.01-3.42]). Insurance status and income were not associated with differences in PCC. At our institution, we found no evidence of racial/ethnic, insurance, or income status affecting PCC while primary language spoken and educational status did. Further investigation is warranted to examine the system and provider-level factors influencing PCC’s low utilization by medical and surgical specialties.

scholarly journals Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center

2017 ◽  
Vol 20 (4) ◽  
pp. 372-377 ◽  
Author(s):  
May Hua ◽  
Guohua Li ◽  
Caitlin Clancy ◽  
R. Sean Morrison ◽  
Hannah Wunsch
Keyword(s):  
Palliative Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Palliative Care Consultation ◽  
Academic Medical ◽  
Care Consultation

scholarly journals What’s Race got to do With it? How Palliative Care Consultation may Mitigate Racial Disparities in Future Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 877-877
Author(s):  
Lauren Starr ◽  
Connie Ulrich ◽  
G Adriana Perez ◽  
Subhash Aryal ◽  
Paul Junker ◽  
...  
Keyword(s):  
Palliative Care ◽  
Racial Disparities ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Analysis ◽  
Female Gender ◽  
Black Race ◽  
Palliative Care Consultation ◽  
Hospitalization Costs ◽  
Care Consultation

Abstract It is unknown if care and cost outcomes differ by race and ethnicity following discharge from a hospitalization involving palliative care consultation to discuss goals-of-care (PCC). In this secondary analysis of 1,390 seriously-ill patients age 18+ alive at discharge who self-identified as Black, Hispanic, Asian, white, or other race and received PCC at an urban, academic medical center, we used binomial logistic regression and multiple linear regression controlling for demographic and clinical variables to identify factors associated with care experiences and costs following discharge from a hospitalization with PCC. In adjusted analyses, discharge to hospice was associated with Medicaid (p=0.016). Thirty-day readmission was associated with age 75+ (P=0.015), Medicaid (P=0.004), admission 30 days prior (P&lt;0.0001), and Black race compared to white (P=0.016). Number of future days hospitalized was associated with Medicaid (P=0.001), admission 30 days prior (P=0.017), and Black race compared to white (P=0.012). Having any future hospitalization cost was associated with patient ages 65-74 (P=0.022) and 75+ (P=0.023), Medicaid (P=0.014), admission 30-days prior (P&lt;0.0001), and Black race compared to white (P=0.021). Total future hospitalization costs were associated with female gender (P=0.025), Medicaid (P=0.009), admission 30 days prior (P=0.040), and Black race compared to white (P=0.037). Race or ethnicity was not a predictor of hospice enrollment. Randomized controlled trials are needed to understand if PCC is an intervention that reduces racial disparities in end-of-life care. Qualitative insights are needed to explain how PCC and socioeconomic factors such as Medicaid may mitigate future acute care use among racial and ethnic groups.

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