Trends, Sociodemographic and Hospital-Level Factors Associated With Palliative Care Utilization Among Multiple Myeloma Patients Using the National Inpatient Sample (2016-2018)

2021 ◽  
pp. 104990912110516
Author(s):  
Inimfon Jackson ◽  
Nsikak Jackson ◽  
Aniekeme Etuk
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
Private Insurance ◽  
Care Utilization ◽  
National Inpatient Sample ◽  
Hospital Level ◽  
Cross Sectional ◽  
Factors Associated ◽  
Patient Disposition ◽  
Prevalence Trends

Background: Several factors are reported to be associated with palliative care utilization among patients with various cancers, but literature is lacking on multiple myeloma (MM) specific factors. MM patients have a high symptom burden and early involvement of palliative could increase their quality of life. We examined factors associated with palliative care utilization among MM patients and explored prevalence trends in palliative care utilization among patients with MM. Methods: Cross-sectional analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore prevalence trends in palliative care utilization over time. Multivariable logistic regression models were used to examine sociodemographic and hospital-level factors associated with palliative care utilization in MM patients. Results: Overall prevalence of palliative care utilization in our population was 7.7% with a trend of increasing use of palliative care from 7.3% in 2016 to 8.2% in 2018. MM patients aged 70 years and above had 1.30 times higher odds (95% CI: 1.20-1.42) of receiving palliative care relative to those younger than 70 years. Compared to non-Hispanic whites, non-Hispanic blacks (Adjusted odds ratio (AOR): 0.86; 95% CI: 0.79-0.94) were less likely to utilize palliative care. Patients on Medicaid (AOR: 1.27; 95% CI: 1.08-1.49), private insurance (AOR: 1.27; 95% CI: 1.16-1.39) and other insurance types (AOR: 2.10; 95% CI: 1.79-2.47) had significantly higher odds of receiving palliative care when compared to those on Medicare. Other factors identified were hospital region, location, patient disposition, admission type, length of stay, and number of comorbidities. Conclusion: Our findings highlight the urgent need for education of hospital physicians on the need for early palliative care involvement in the care of hospitalized MM patients. Messaging interventions such as the delivery of pop-up messages in electronic medical records to serve as reminders for physicians can be explored as a potential way to increase palliative care consultations for patients who need them.

scholarly journals Disparities of Palliative Care Utilization in End-of-Life Hospitalized Patients with Leukemia: An Analysis of National Inpatient Sample Database

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3063-3063
Author(s):  
Tien-Chan Hsieh ◽  
Yee Hui Yeo ◽  
Guangchen Zou ◽  
Jeanine Famiglietti
Keyword(s):  
Palliative Care ◽  
African American ◽  
End Of Life ◽  
Conflicts Of Interest ◽  
Private Insurance ◽  
Hospitalized Patients ◽  
Limiting Factors ◽  
Care Utilization ◽  
National Inpatient Sample ◽  
Hospital Size

Abstract Background: Early palliative care (PC) encounter has been shown to improve the quality of end-of-life (EOL) care. There is a significant increased in the PC utility of leukemia patients in the past decade. We aim to investigate the use of PC service in hospitalized patients with leukemia and other malignancies at the end of their life. Methods: This is a retrospective study of National Inpatient Sample (NIS) with data year 2016-2018. The cohort of interest was adult patients (age at least 18) who had been hospitalized for at least three days and passed away. International Classification of Diseases, 10th Revision was used to identify patients with leukemia (myeloid, lymphoid and other types), other malignancies, comorbidities, PC encounters, and procedures. Primary outcome was PC encounter. PC-associated factors were analyzed with multivariate logistic regression. Statistical analysis was performed with SAS and R. Results: Among 404,011 hospitalized patients who passed away, a total of 254,431 patients stayed in the hospital for at least three days. There were 5,819 (lymphoid: 2,177; myeloid: 2,848; other: 794) and 56,270 patients had leukemia and other malignancies, respectively. 51.4% leukemia, 57.4% other malignancies and 46.2% non-cancer patients had PC encounter. The PC use significantly increased in all subgroups from 2016 to 2018 (p < 0.0001). The PC utility of leukemia patients improved from 47.4% in 2016 to 55.4% in 2018. Compared to patients with other malignancies, leukemia patients had higher portion of mechanical ventilation use and cardiopulmonary resuscitation (CPR) prior to their death (31.6% vs 40.0%, p < 0.005). The PC utility was significantly higher in other malignancies group (adjusted odds ratio [aOR]: 1.37, p < 0.0001) and lower in non-cancer group (aOR: 0.85, p < 0.0001). Advanced age, female, Medicaid, private insurance, self-pay, higher income, larger hospital size, urban hospital, Midwest and West Region year of 2017 and 2018 were also associated with increased PC utility and African American, Hispanic, Asian or Pacific Islander, South region were associated with lower odds of receiving PC (Figure 1). Among leukemia patients, myeloid leukemia group had higher odds of PC encounter than lymphoid group (aOR: 1.28, p < 0.0001). African American, Hispanic, lower income, and smaller hospital were associated with significantly lower PC consult in leukemia patients. Conclusion: There was an encouraging trend of increased PC consult between 2016 to 2018. Nevertheless, the PC utility was still lower among EOL hospitalized patients with leukemia than with other malignancies. Racial, socioeconomic, and hospital resource disparities were significant limiting factors of PC accessibility. Further systemic intervention and investigation are required to improve the disparities of PC utilization in leukemia patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Sociodemographic and Hospital Level Disparities in Palliative Care Utilization Among Terminally Ill Patients with Multiple Myeloma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3594-3594 ◽  
Author(s):  
Kahee A Mohammed ◽  
Nosayaba Osazuwa-Peters ◽  
Kristen M Sanfilippo
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
Logistic Regression ◽  
End Of Life ◽  
Terminally Ill ◽  
Multivariate Logistic Regression Analysis ◽  
Care Utilization ◽  
Do Not Resuscitate ◽  
Hospital Level ◽  
Terminally Ill Patients

Abstract Background. The National Comprehensive Cancer Network guidelines recommend that physicians discuss end-of-life planning with patients with incurable cancer and a life expectancy of less than 1 year. Integration of palliative medicine approaches to end-of-life care improves quality of life, patient and caregiver satisfaction, and significantly reduces health care costs. However, there is a paucity of data regarding end-of-life and palliative care use in patients with multiple myeloma. This study aimed to evaluate trends in the incidence of palliative care use and explore patient and hospital level disparities in palliative care use in terminally ill patients with multiple myeloma. Methods. We performed a population-based cross-sectional study using data from the Nationwide Inpatient Sample from 2008 through 2014. International Classification of Diseases-9-Clinical Modification codes were used to identify hospitalized patients (aged ≥ 18 years) with multiple myeloma who died in the hospital. Sociodemographic, comorbidities, and hospital level characteristics were compared using chi square tests and independent sample t tests. Trends in palliative care use were assessed using the Cochrane-Armitage test. Multivariate logistic regression analysis was used to create a predictive model of palliative care use. Results. Of the 7789 patients with multiple myeloma who died in the hospital during the study period, 32.5% received palliative care. Utilization of palliative care increased annually, from 17.3% in 2008 to 43.0% in 2014 (trend P < .001). After adjustment for multiple patient and hospital level covariates in logistic regression, we found a lower likelihood of palliative care use in Black race (odds ratio [OR] = 0.72, 95% Confidence Interval [CI] = 0.62 - 0.82), Hispanic race (OR = 0.48, 95% CI = 0.38 - 0.60), and patients with higher Elixhauser comorbidity index (OR = 0.88, 95% CI = 0.86 - 0.91) whereas higher likelihood of palliative care use were found among uninsured patients (OR = 2.17, 95% CI = 1.73 - 2.72) and patients with Do Not Resuscitate (DNR) status (OR = 3.35, 95% CI = 2.97 - 3.78). Independent hospital level correlates of palliative care use included: admission to teaching vs. non-teaching (OR = 1.29, 95% CI = 1.15 - 1.45), admission to larger vs. small sized hospitals (OR = 1.24, 95% CI = 1.05 - 1.46), and admission to hospitals located in Midwest (OR = 1.33 95% CI = 1.14 - 1.54) and West (OR = 1.63, 95% CI = 1.41 - 1.90) vs South. Conclusion: There is a nationally increasing trend in palliative care utilization over the last decade. This study highlights disparities across race/ethnicity, insurance status, geographic region, and other hospital level factors in palliative care use in terminally ill patients with multiple myeloma. While some of the hospital-level disparities can be explained by the relative lack of palliative services in small non-teaching hospitals, barriers to accessing palliative care services needs to be thoroughly investigated and addressed to ensure equal access to this important aspect of care in terminally ill cancer patients. Disclosures Sanfilippo: Bristol-Myers Squibb: Speakers Bureau.

Factors associated with feelings of reward during ongoing family palliative caregiving

2014 ◽  
Vol 13 (3) ◽  
pp. 505-512 ◽  
Author(s):  
Anette Henriksson ◽  
Ida Carlander ◽  
Kristofer Årestedt
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Influential Factors ◽  
Cross Sectional ◽  
Spousal Relationship ◽  
Factors Associated ◽  
Specialized Palliative Care ◽  
Cross Sectional Design ◽  
Bereaved Family ◽  
Demographic Background

AbstractObjective:Of the few studies that have paid attention to feelings of reward in family palliative caregiving, most are retrospective and examine the experiences of bereaved family caregivers. Although feeling rewarded has been described as an influence that may facilitate the way family caregivers handle the caregiving situation, no study has sought to identify the factors associated with feelings of reward while providing ongoing family palliative care. The aim of this study, therefore, was to identify influential factors in feelings of reward experienced by family palliative caregivers.Method:Our study had a correlational cross-sectional design. Family caregivers (n = 125) of patients receiving specialized palliative care were consecutively recruited from four settings. These caregivers answered a questionnaire that included the Rewards of Caregiving Scale (RCS). This questionnaire included questions about demographic background and scales to measure preparedness for caregiving, feelings of hope, perceived health, and symptoms of anxiety and depression. Correlation and regression analyses were conducted to identify factors associated with rewards.Results:The results demonstrated that the more prepared caregivers with higher levels of hope felt more rewarded, while caregivers with higher levels of anxiety and those in a spousal relationship with the patient felt less rewarded by caregiving.Significance of results:It seems reasonable that feeling rewarded can be a significant contributor to the overall experience of providing ongoing palliative care. The situation of family caregivers has been shown to be multifaceted and complex, and such covariant factors as preparedness, anxiety, hope, and being in a spousal relationship with the patient to influence this experience.

scholarly journals Hospitalization costs among immobile patients with hemorrhagic or ischemic stroke in China: a multicenter cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hongpeng Liu ◽  
Chen Zhu ◽  
Jing Cao ◽  
Jing Jiao ◽  
Baoyun Song ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Linear Regression ◽  
Average Length ◽  
Linear Regression Analysis ◽  
Hospital Charges ◽  
Hospital Level ◽  
Cross Sectional ◽  
Factors Associated ◽  
Hospitalization Costs

Abstract Background In this study, we aimed to analyze the hospitalization costs for immobile patients with hemorrhagic stroke (IHS) or ischemic stroke (IIS) in China and to determine the factors associated with hospitalization costs. Methods We evaluated patients with IHS and IIS hospitalized between November 2015 and July 2016 in six provinces or municipality cities of China. Linear regression analysis was used to examine the association with hospitalization costs and predictors. Results In total, 1573 patients with IHS and 3143 with IIS were enrolled and analyzed. For IHS and IIS, the average length of stay (LoS) was 17.40 ± 12.3 and 14.47 ± 11.55 days. The duration of immobility was 12.11 ± 9.98 and 7.36 ± 9.77 days, respectively. Median hospitalization costs were RMB 47000.68 (interquartile range 19,827.37, 91,877.09) for IHS and RMB 16578.44 (IQR 7020.13, 36,357.65) for IIS. In both IHS and IIS groups, medicine fees accounted for more than one-third of hospitalization costs. Materials fees and medical service fees accounted for the second and third largest proportions of hospital charges in both groups. Linear regression analysis showed that LoS, hospital level, and previous surgery were key determinants of hospitalization costs in all immobile patients with stroke. Subgroup analysis indicated that hospital level was highly correlated with hospitalization costs for IHS whereas pneumonia and deep vein thrombosis were key factors associated with hospitalization costs for IIS. Conclusions We found that hospitalization costs were notably higher in IHS than IIS, and medicine fees accounted for the largest proportion of hospitalization costs in both patient groups, perhaps because most patients ended up with complications such as pneumonia thereby requiring more medications. LoS and hospital level may greatly affect hospitalization costs. Increasing the reimbursement ratio of medical insurance for patients with IHS is recommended. Decreasing medicine fees and LoS, preventing complications, and improving treatment capability may help to reduce the economic burden of stroke in China.

Caring for the caregiver: factors associated with the quality of life of family caregivers to palliative care patients

2015 ◽  
Vol 3 (3) ◽  
pp. 352
Author(s):  
Macarena Quesada ◽  
Manuel Madrigal ◽  
Aurelio Luna ◽  
Maria D Perez-Carceles
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Family Caregivers ◽  
Care Patient ◽  
Terminal Phase ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Impact

Purpose: The aim was to investigate the factors associated with the quality of life (QoL) of family caregivers to palliative care patients. Methods: A cross-sectional survey was conducted of 125 family caregivers of patients in the terminal phase of their illness and included in palliative care programs. Data were collected using WHOQOL-BREF, the socio-demographic characteristics of both caregiver and patient, clinical questions and information about caregiving. Results: The QoL of caregivers was lower than that of the national average for healthy people. Significantly lower QoL scores were obtained in the case of caregivers if they were women, over 55 years, uneducated, unemployed or the patient’s spouse. Cancer diagnosis and patients who were dependent for their Activities of Daily Living also lower caregiver QoL. The factors associated with higher caregiver QoL in each domain differed: being employed in the physical domain (OR:3.3; 95% CI:1.47-7.4), the patient receiving palliative care in hospital in the psychological domain (OR:3.05; 95% CI:1.19-7.7), a higher level of caregiver´s education in the social domain (OR:3.3; 95% CI:1.4-9.8) and caregivers between 45-55 years in the environmental domain (OR:5.4; 95% CI:1.6-9.2).Conclusion: Family caregivers of palliative care patients are highly burdened during caregiving. Characteristics of the patient and caregiver and the conditions under which care is performed, significantly affect QoL. We consider it essential to increase health professionals’ awareness of the importance of the role of the caregiver in providing services to the terminally ill, given the impact of the caregiver’s QoL on the QoL of the palliative care patient and its importance for the delivery of person-centered care at the end of life.    

Factors associated with wide variation in clinical litigation rates across acute NHS trusts in England: a cross-sectional analysis

2020 ◽  
Author(s):  
Beverley Griggs ◽  
Tristan Childs ◽  
Jamie Birkinshaw ◽  
Padmanabhan Badrinath
Keyword(s):  
Routine Data ◽  
Organizational Factors ◽  
Hospital Level ◽  
Cross Sectional ◽  
Level Indicator ◽  
Factors Associated ◽  
Cross Sectional Analysis ◽  
The North ◽  
Bed Days ◽  
Sectional Analysis

Abstract Objective Identify organizational factors associated with high clinical litigation rates among acute National Health Service (NHS) trusts in England. Design Cross-sectional analysis using routine data. Setting NHS trusts in England. Participants A total of 235 NHS trusts used the NHS Clinical Negligence Scheme in 2016–17. Ninety-seven trusts (41.3%) with no maternity services, 2 (0.9%) providing specialized services and 3 (1.2%) without clinical negligence claims were excluded. Hence, the remaining 133 trusts (56.6%) were included. Intervention(s) None. Main Outcome Measures Rate of clinical litigation by trust per 100 000 occupied bed days. Results The mean rate of clinical litigation was 25.4 per 100 000 occupied bed days. In univariable analyses, higher values of summary hospital-level mortality indictor, staff sickness, written complaints, patient safety incidents and being in the North of England led to increased clinical litigation rates. Conversely, higher patient admissions, NHS Staff Survey overall engagement score and occupied bed days led to decreased clinical litigation rates. In the multivariable model, factors associated with increased clinical litigation rates were as follows: summary mortality hospital-level indicator (SHMI) (0.9 increase in litigation rate per 0.05 increase in SHMI; P = 0.012); new written complaints (0.62 increase per 50 complaints higher; P &lt; 0.001); located in the North of England compared to London (5.22 higher; P &lt; 0.001). Conversely, a higher number of occupied bed days (−0.64 change per 50 000 days higher; P = 0.007) was associated with lower clinical litigation rates. Conclusions This study identified organizational factors associated with clinical litigation, which will be of interest to clinicians and the NHS. This research also highlights areas for further investigation.

Factors associated with palliative care utilization in advanced and metastatic renal cell carcinoma.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 146-146
Author(s):  
Hiren V. Patel ◽  
Joshua Sterling ◽  
Arnav Srivastava ◽  
Sinae Kim ◽  
Biren Saraiya ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Palliative Care ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Stage Iv ◽  
Stage Iii ◽  
Care Utilization ◽  
Clinical Factors ◽  
Factors Associated ◽  
Specific Manner

146 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with Stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC among the overall cohort and treatment-based cohorts. Results: Among 20,122 and 42,014 patients with Stage III and IV RCC, 329 and 9,317 patients received PC, respectively. From 2004 to 2014, PC utilization was stable at ̃1% for Stage III RCC and minimally increased from 17% to 20% for Stage IV RCC. Multivariable analysis demonstrated that increased comorbidities, insurance status, higher education status, facility location, care at a comprehensive cancer program or integrated network, sarcomatoid histology, and prior treatments significantly increased likelihood of palliative care utilization. We uncover socioeconomic and clinical factors that are associated with receipt of palliative care use in a treatment-specific manner. Conclusions: While PC utilization has minimally increased for Stage IV RCC, there are several demographic, socioeconomic, and clinical factors that predict PC use, especially in a treatment-specific manner, among patients with advanced RCC. Taken together, this suggests the need for more equitable and systematic use of PC among patients with advanced RCC.

Disparities in Palliative Care Utilization Among Hospitalized People With Huntington Disease: A National Cross-Sectional Study

2021 ◽  
pp. 104990912110344
Author(s):  
Leonard L. Sokol ◽  
Danny Bega ◽  
Chen Yeh ◽  
Benzi M. Kluger ◽  
Hillary D. Lum
Keyword(s):  
Palliative Care ◽  
Cross Sectional Study ◽  
Healthcare Research ◽  
Care Utilization ◽  
Cross Sectional ◽  
Discharge Data ◽  
Home Setting ◽  
Serious Illness ◽  
Discharge Disposition ◽  
Specific Factors

Background: People with Huntington’s disease (HD) often become institutionalized and more frequently die away from the home setting. The reasons behind differences in end-of-life care are poorly understood. Less than 5% of people with HD report utilization of palliative care (PC) or hospice services, regardless of the lack of curative therapies for this neurodegenerative disease. It is unknown what factors are associated with in-patient specialty PC consultation in this population and how PC might be related to discharge disposition. Objectives: To determine what HD-specific (e.g., psychosis) and serious illness-specific factors (e.g., resuscitation preferences) are associated with PC encounters in people with HD and explore how PC encounters are associated with discharge disposition. Design: We analyzed factors associated with PC consultation for people with HD using discharge data from the National Inpatient Sample and the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. An anonymized, cross-sectional, and stratified sample of 20% of United States hospitalizations from 2007 through 2014 were included using ICD-9 codes. Results: 8521 patients with HD were admitted to the hospital. Of those, 321 (3.8%) received specialty PC. Payer type, (specifically private insurer or other insurer as compared to Medicare), income, (specifically the top quartile as compared to the bottom quartile), mortality risk, D.N.R., aspiration pneumonia, and depression were significantly associated with PC in a multivariate model. Among those who received PC, the odds ratio (OR) of discharge to a facility was 0.43 (95% CI, 0.32-0.58), whereas the OR of discharge to home with services was 2.25 (95% CI 1.57-3.23), even after adjusting for possible confounders. Conclusions: Among patients with HD, economic factors, depression, and serious illness-specific factors were associated with PC, and PC was associated with discharge disposition. These findings have implications for the adaptation of inpatient PC models to meet the needs of persons with HD.

scholarly journals Factors associated with delays in seeking tuberculosis treatment among patients at Muhima district hospital, Rwanda

2020 ◽  
Vol 7 (8) ◽  
pp. 3183
Author(s):  
Chinenye Mercy Nwankwo ◽  
Yasmin Umubyeyi Omar
Keyword(s):  
District Hospital ◽  
Private Insurance ◽  
Sampling Technique ◽  
Population Data ◽  
Systematic Sampling ◽  
Time Interval ◽  
Case Detection ◽  
Cross Sectional ◽  
Factors Associated ◽  
Insurance Cover

Background: Few studies exist in Rwanda to establish the reasons behind delays in seeking treatment in the health institutions which further affected timely diagnosis and case detection. The study investigated factors associated with delays in seeking treatment among tuberculosis (TB) patients at Muhima District Hospital, Rwanda.Methods: The study adopted descriptive cross- sectional study of 49 smear-positive TB patients derived using proportion estimation of case registry (November 2016 to January 2017) newly- diagnosed patients, first and second months treatment. Systematic sampling technique used to select 60 TB patients from target population. Data collected by researcher and trained research assistant, using a close- ended questionnaire through a translation in local dialect.Results: About 49% (24) of the smear- positive TB patients experienced delayed in seeking treatment for more than 180 days (6 months). Also 53% (26) were within the 36-45 age-cohort, while majority 75.5% (37) of the respondents was male. About 57% (28) of the respondents have poor knowledge of TB transmission. Similarly, about 51% (25) were the results on the perception of taking anti- TB medication, while median time interval from onset of symptoms and initiation of treatments was 45 days, average 71 days between 15 -180 days.Conclusions: Statistically significant relationship exist between initial source of treatment using home remedies (p=0.0) and private insurance cover (p=0.0) in relation to delay, which further contributed to delay among majority. Recommendations of the study are strengthening medical services utilization, improving case detection, medical infrastructures and collaboration with non- formal healthcare practices.

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