Integrative palliative care, advance directives, and hospital outcomes of critically ill older adults.

OBJECTIVE: To examine the associations between palliative care types and hospital outcomes for patients who have or do not have advance directives.
METHOD: Using administrative claims and clinical data for critically ill older adults (n = 1291), multivariable regressions examined the associations between palliative care types and hospital outcomes by advance directive status.
RESULTS: Integrative palliative care was associated with lower hospital costs, lower adjusted probability of in-hospital deaths, and higher adjusted probability of hospice discharges. There was no difference in hospital outcomes by palliative care types in those with advance directives.
CONCLUSION: Significantly lower hospital costs and in-hospital deaths with higher hospice discharges were observed in integrative palliative care compared to consultative palliative care, but these findings were diminished with the presence of advance directives.