Elizabeth Wagner1,2, Donald L Patrick2, Nita Khandelwal1,3, Lyndia Brumback1,4, Helene Starks1,2,5,6, James Fausto6, Benjamin S Dunlap1,7, William Lober1,8, James Sibley1,8, Elizabeth T Loggers9,10, J Randall Curtis1,7, Ruth A Engelberg1,7. 1. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington. 2. Department of Health Services, University of Washington, Seattle, Washington. 3. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington. 4. Department of Biostatistics, University of Washington, Seattle, Washington. 5. Department of Bioethics and Humanities, and University of Washington, Seattle, Washington. 6. Department of Family Medicine, University of Washington, Seattle, Washington. 7. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington. 8. Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington. 9. Seattle Cancer Care Alliance, Seattle, Washington. 10. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Abstract
Objective: To evaluate the association between the number of chronic conditions and hospital utilization at the end of life. Background: An understanding of the association of multimorbidity with health care utilization at the end of life may inform interventions to improve quality of care for these patients. Methods: A mortality follow-back analysis using Washington State death records and electronic health records. Subject included patients in the UW Medicine system who had at least one chronic condition and died between 2010 and 2015. Utilization was measured by inpatient admissions, emergency department use, and intensive care unit (ICU) admissions in the last 30 days of life. Results: For all utilization types, patients with three or more chronic conditions (n = 5124) had significantly higher utilization (p < 0.001) in the last 30 days of life than those with two (n = 5775) or one condition (n = 11,169). Comparing 3 versus 2 versus 1 conditions, the following percentages of patients had each type of utilization: inpatient admissions (37% vs. 28% vs. 19%), ED admissions (5% vs. 4% vs. 2%), and ICU care (28% vs. 20% vs. 12%). Discussion: Multimorbidity was associated with greater health care utilization at the end of life among patients representing a range of ages and covered by diverse insurers.
Objective: To evaluate the association between the number of chronic conditions and hospital utilization at the end of life. Background: An understanding of the association of multimorbidity with health care utilization at the end of life may inform interventions to improve quality of care for these patients. Methods: A mortality follow-back analysis using Washington State death records and electronic health records. Subject included patients in the UW Medicine system who had at least one chronic condition and died between 2010 and 2015. Utilization was measured by inpatient admissions, emergency department use, and intensive care unit (ICU) admissions in the last 30 days of life. Results: For all utilization types, patients with three or more chronic conditions (n = 5124) had significantly higher utilization (p < 0.001) in the last 30 days of life than those with two (n = 5775) or one condition (n = 11,169). Comparing 3 versus 2 versus 1 conditions, the following percentages of patients had each type of utilization: inpatient admissions (37% vs. 28% vs. 19%), ED admissions (5% vs. 4% vs. 2%), and ICU care (28% vs. 20% vs. 12%). Discussion: Multimorbidity was associated with greater health care utilization at the end of life among patients representing a range of ages and covered by diverse insurers.
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