Elizabeth Chuang1, Aluko A Hope2, Katherine Allyn3, Elissa Szalkiewicz4, Brittany Gary4, Michelle N Gong5. 1. Department of Family and Social Medicine, Palliative Care Service, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York. Electronic address: echuang@montefiore.org. 2. Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York. 3. Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York. 4. Department of Medicine, Montefiore Medical Center, Bronx, New York. 5. Division of Critical Care Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Abstract
CONTEXT: Previous research has identified a large unmet need in provision of specialist-level palliative care services in the hospital. How much of this gap is filled by primary palliative care provided by generalists or nonpalliative specialists has not been quantified. Estimates of racial and ethnic disparities have been inconsistent. OBJECTIVES: The objective of this study was to 1) estimate primary and specialty palliative care delivery and to measure unmet needs in the inpatient setting and 2) explore racial and ethnic disparities in palliative care delivery. METHODS: This was a cross-sectional, retrospective study of 55,658 adult admissions to two acute care hospitals in the Bronx in 2013. Patients with palliative care needs were identified by criteria adapted from the literature. The primary outcomes were delivery of primary and specialist-level palliative care. RESULTS: In all, 18.5% of admissions met criteria for needing palliative care. Of those, 18% received specialist-level palliative care, an estimated 30% received primary palliative care, and 37% had no evidence of palliative care or advance care planning. Black and Hispanic patients were not less likely to receive specialist-level palliative care (adjusted odds ratio [OR] black patients = 1.18, 95% CI 0.98, 1.42; adjusted OR Hispanic patients = 1.24, 95% CI 1.04, 1.48), but they were less likely to receive primary palliative care (adjusted OR black patients = 0.41, 95% CI 0.20, 0.84; adjusted OR Hispanic patients = 0.48, 95% CI 0.25, 0.94). CONCLUSION: Even when considering primary and specialty palliative care, hospitalized patients have a high prevalence of unmet palliative care need. Further research is needed understand racial and ethnic disparities in palliative care delivery.
CONTEXT: Previous research has identified a large unmet need in provision of specialist-level palliative care services in the hospital. How much of this gap is filled by primary palliative care provided by generalists or nonpalliative specialists has not been quantified. Estimates of racial and ethnic disparities have been inconsistent. OBJECTIVES: The objective of this study was to 1) estimate primary and specialty palliative care delivery and to measure unmet needs in the inpatient setting and 2) explore racial and ethnic disparities in palliative care delivery. METHODS: This was a cross-sectional, retrospective study of 55,658 adult admissions to two acute care hospitals in the Bronx in 2013. Patients with palliative care needs were identified by criteria adapted from the literature. The primary outcomes were delivery of primary and specialist-level palliative care. RESULTS: In all, 18.5% of admissions met criteria for needing palliative care. Of those, 18% received specialist-level palliative care, an estimated 30% received primary palliative care, and 37% had no evidence of palliative care or advance care planning. Black and Hispanic patients were not less likely to receive specialist-level palliative care (adjusted odds ratio [OR] black patients = 1.18, 95% CI 0.98, 1.42; adjusted OR Hispanic patients = 1.24, 95% CI 1.04, 1.48), but they were less likely to receive primary palliative care (adjusted OR black patients = 0.41, 95% CI 0.20, 0.84; adjusted OR Hispanic patients = 0.48, 95% CI 0.25, 0.94). CONCLUSION: Even when considering primary and specialty palliative care, hospitalized patients have a high prevalence of unmet palliative care need. Further research is needed understand racial and ethnic disparities in palliative care delivery.
Authors: Teresa Beynon; Barbara Gomes; Fliss E M Murtagh; Ed Glucksman; Andy Parfitt; Rachel Burman; Polly Edmonds; Irene Carey; Jeff Keep; Irene J Higginson Journal: Emerg Med J Date: 2010-10-13 Impact factor: 2.740
Authors: Melissa W Wachterman; Corey Pilver; Dawn Smith; Mary Ersek; Stuart R Lipsitz; Nancy L Keating Journal: JAMA Intern Med Date: 2016-08-01 Impact factor: 21.873
Authors: Anna Santos Salas; Sharon M Watanabe; Yoko Tarumi; Tracy Wildeman; Ana M Hermosa García; Bisi Adewale; Wendy Duggleby Journal: Support Care Cancer Date: 2019-04-10 Impact factor: 3.603
Authors: Lauren T Starr; Connie M Ulrich; Scott M Appel; Paul Junker; Nina R O'Connor; Salimah H Meghani Journal: J Palliat Med Date: 2020-04-27 Impact factor: 2.947
Authors: Julia L Frydman; Melissa Aldridge; Jaison Moreno; Joshua Singer; Li Zeng; Emily Chai; R Sean Morrison; Laura P Gelfman Journal: J Palliat Med Date: 2021-10-08 Impact factor: 2.947
Authors: Elizabeth Chuang; Ryan J Fiter; Omar C Sanon; Ann Wang; Aluko A Hope; Clyde B Schechter; Michelle N Gong Journal: Am J Hosp Palliat Care Date: 2020-04-02 Impact factor: 2.500
Authors: Lauren T Starr; Connie M Ulrich; G Adriana Perez; Subhash Aryal; Paul Junker; Nina R O'Connor; Salimah H Meghani Journal: Am J Hosp Palliat Care Date: 2021-07-28 Impact factor: 2.090