Palliative care and end-of-life health care utilization of pancreatic cancer patients at an urban safety-net hospital.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 489-489
Author(s):  
Nizar Bhulani ◽  
M. Elizabeth Paulk ◽  
Arjun Gupta ◽  
Kiauna Donnell ◽  
Valorie Harvey ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Safety Net ◽  
Care Utilization ◽  
Safety Net Hospital

489 Background: There has been an increase in Palliative care utilization in cancer patients. We examined trends of palliative care and intensive care utilization in pancreatic cancer patients in an urban setting safety net hospital. Methods: This is a retrospective analysis of pancreatic cancer patients seen at the Parkland Health and Hospital System between January 1999 and September 2016. Cancer cases and receipt of palliative care were identified from prospectively maintained registries. Health care utilization including intensive care unit (ICU) was reviewed. All statistical analysis was done using IBM SPSS version 24. Results: We identified 455 new diagnoses of pancreatic cancer, mean age 61 years, 227 (50%) female and 228 (50%) white. Of these, 277 (61%) received palliative care ever. Patient who received palliative care were more likely to be younger (mean age, 59.3+-12 vs 62.8 +- 12 years) and have stage 4 disease vs stage 1-3 disease (p 0.006, and p 0.003 respectively). There was no statistically significant difference in palliative care utilization between gender and ethnicity groups. 140 patients had a DNR order and 29 required ICU admission at any point. A first contact with palliative care consult was obtained < = 7 days before death for 29 (10%) patients, < = 30 days before death for 86 (31%) patients, 30-60 days before death for 50 (18%) and more than 60 days before death for 141 (51%) patients. Patients receiving palliative care were more likely to have a DNR status (p < 0.001) but had no difference in ICU use within the last 30 days of life (p 0.285). Conclusions: The rate of palliative care in patients with pancreatic cancer in this cohort from a safety net hospital is higher than nationally reported studies. Most patients received palliative care > 30 days before death. While patients received early palliative care, it did not result in reduced ICU care. Factors influencing ICU care utilization near the end of life need further study.

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

scholarly journals Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer

2018 ◽  
Vol 9 (3) ◽  
pp. 495-502 ◽  
Author(s):  
Nizar Bhulani ◽  
Arjun Gupta ◽  
Ang Gao ◽  
Jenny Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Elderly Patients ◽  
Health Care Utilization ◽  
End Of Life ◽  
Care Utilization

Health care utilization and patient-related outcomes in patients with malignant bowel obstruction admitted to a United States safety net hospital.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 50-50
Author(s):  
Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar Mukthinuthalapati ◽  
Aakash Putta ◽  
Ishaan Vohra ◽  
Vatsala Katiyar ◽  
Krishna Moturi ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Surgical Management ◽  
End Of Life Care ◽  
Safety Net ◽  
Care Utilization ◽  
Life Care ◽  
Malignant Bowel Obstruction ◽  
Safety Net Hospital

50 Background: Malignant bowel obstruction (MBO) and gastric outlet obstruction (GOO) can be a late complication of intra-abdominal malignancy with a poor prognosis. Most studies about its outcomes have focused on survival. There is paucity of studies assessing health care utilization and end of life care decisions. Methods: We retrospectively collected data from the electronic medical record of patients admitted with MBO or GOO at a safety-net hospital in Chicago, US between January 2013 and December 2017. The charts were analyzed for outcomes related to end of life care and health care utilization. The outcomes were compared by across three broad treatment arms: those that received surgical intervention, those that received venting gastrostomy (VG) and those that were treated medically alone. Results: Forty-six patients were identified of which 31 were admitted with MBO. 25 (54%) of them were due to stage IV cancers. Mean age of study population was 61 years. Surgical management, VG and medical management were done in 17, 8 and 21 patients respectively. There was no difference in ICU admission rate, length of stay of index admission, 90 day-readmission rate or mean visits to the ER between the groups. Patients receiving venting gastrostomy tube had highest rate of oral solid food tolerability. Twenty-eight patients died or were enrolled in hospice within a median of 115 days. Conclusions: All modalities of treatment had similar health utilization measures in patients with MBO and GOO. Surgical management, if feasible, has the longest time to hospice enrollment or death and should be offered to patients who are suitable. [Table: see text]

End-of-life health care utilization of gynecologic cancer patients at an urban, public hospital

2012 ◽  
Vol 127 (1) ◽  
pp. S12
Author(s):  
E. Wu ◽  
A. Rogers ◽  
L. Ji ◽  
R. Sposto ◽  
A. Mittra ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Public Hospital ◽  
Gynecologic Cancer ◽  
Care Utilization

scholarly journals Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience

2018 ◽  
Vol 36 (5) ◽  
pp. 408-416
Author(s):  
Heather R. Britt ◽  
Meghan M. JaKa ◽  
Karl M. Fernstrom ◽  
Paige E. Bingham ◽  
Anne E. Betzner ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Palliative Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Care Utilization ◽  
Serious Illness ◽  
Care Experience ◽  
Quasi Experimental

Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life. Enrolled patients (N = 903) were estimated to be within 3 years of end of life and diagnosed with 1+ serious illness. Exclusion criteria included hospice enrollment at time of screening or active dying. Community health workers (CHWs) delivered standardized monthly 1-hour home visits based on palliative care guidelines and motivational interviewing to promote patients’ physical, psychosocial, and financial well-being. Primary outcomes included health-care utilization and patient- and caregiver-experience and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis (LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N = 173, 38%) than UC patients (N = 66, 15%; P < .001). LifeCourse patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ± 71 days; P = .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience ( P = .016). Implementation of person-centered programs delivered by CHWs is feasible; inexpensive upstream expansion of palliative care models can yield benefits for patients and caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at ClinicalTrials.gov .

scholarly journals Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life

2017 ◽  
Vol 15 (10) ◽  
pp. 1612-1619.e4 ◽  
Author(s):  
Arpan A. Patel ◽  
Anne M. Walling ◽  
Joni Ricks-Oddie ◽  
Folasade P. May ◽  
Sammy Saab ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Liver Disease ◽  
Health Care Utilization ◽  
End Of Life ◽  
Care Utilization ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Association of Palliative Care Use and Setting With Health-care Utilization and Quality of Care at the End of Life Among Patients With Advanced Lung Cancer

CHEST Journal ◽  
2020 ◽  
Vol 158 (6) ◽  
pp. 2667-2674 ◽  
Author(s):  
Kelly C. Vranas ◽  
Jodi A. Lapidus ◽  
Linda Ganzini ◽  
Christopher G. Slatore ◽  
Donald R. Sullivan
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Palliative Care ◽  
Quality Of Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Advanced Lung Cancer ◽  
Care Utilization
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