Seelwan Sathitratanacheewin1, Ruth A Engelberg2, Lois Downey2, Robert Y Lee2, James A Fausto3, Helene Starks4, Ben Dunlap2, James Sibley5, William Lober5, Elizabeth T Loggers6, Nita Khandelwal7, J Randall Curtis8. 1. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 2. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA. 3. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Family Medicine, University of Washington, Seattle, Washington, USA. 4. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA. 5. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Bioinformatics and Medical Education, University of Washington, Seattle, Washington, USA. 6. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Seattle Cancer Care Alliance, Seattle, Washington, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 7. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA. 8. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA. Electronic address: jrc@u.washington.edu.
Abstract
CONTEXT: Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age. OBJECTIVES: To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 vs. ≥65 years) who received care in a large healthcare system. METHODS: Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression. RESULTS: The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = -0.026; CI = -0.041, -0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = -0.023; CI = -0.039, -0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU. CONCLUSION: From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions.
CONTEXT: Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age. OBJECTIVES: To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 vs. ≥65 years) who received care in a large healthcare system. METHODS: Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression. RESULTS: The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = -0.026; CI = -0.041, -0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = -0.023; CI = -0.039, -0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU. CONCLUSION: From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions.
Authors: Kyle Lavin; Dimitry S Davydow; Lois Downey; Ruth A Engelberg; Ben Dunlap; James Sibley; William B Lober; Kelson Okimoto; Nita Khandelwal; Elizabeth T Loggers; Joan M Teno; J Randall Curtis Journal: J Pain Symptom Manage Date: 2017-05-09 Impact factor: 3.612
Authors: Fred Burge; Beverley Lawson; Grace Johnston; Yukiko Asada; Paul F McIntyre; Gordon Flowerdew Journal: J Palliat Med Date: 2015-09-23 Impact factor: 2.947
Authors: Joan M Teno; Pedro L Gozalo; Julie P W Bynum; Natalie E Leland; Susan C Miller; Nancy E Morden; Thomas Scupp; David C Goodman; Vincent Mor Journal: JAMA Date: 2013-02-06 Impact factor: 56.272
Authors: J C Weeks; E F Cook; S J O'Day; L M Peterson; N Wenger; D Reding; F E Harrell; P Kussin; N V Dawson; A F Connors; J Lynn; R S Phillips Journal: JAMA Date: 1998-06-03 Impact factor: 56.272
Authors: J Randall Curtis; Seelwan Sathitratanacheewin; Helene Starks; Robert Y Lee; Erin K Kross; Lois Downey; James Sibley; William Lober; Elizabeth T Loggers; James A Fausto; Charlotta Lindvall; Ruth A Engelberg Journal: J Palliat Med Date: 2017-11-28 Impact factor: 2.947