Deven Lackraj1, Dio Kavalieratos2, Komal P Murali3, Yewei Lu1, May Hua1,4. 1. Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA. 2. Division of Palliative Medicine, Department of Family and Preventative Medicine, Emory University, Atlanta, Georgia, USA. 3. School of Nursing, Columbia University, New York, New York, USA. 4. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
Abstract
BACKGROUND: In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization. OBJECTIVE: To determine whether implementation of hospital-based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia. DESIGN: Retrospective cohort study. SETTING: Fifty-one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded. PARTICIPANTS: Hospitalized patients with dementia. MEASUREMENTS: The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference-in-difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends. RESULTS: During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19-1.51), P < .001). No meaningful differences in secondary outcomes were observed. CONCLUSION: Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.
BACKGROUND: In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization. OBJECTIVE: To determine whether implementation of hospital-based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia. DESIGN: Retrospective cohort study. SETTING: Fifty-one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded. PARTICIPANTS: Hospitalized patients with dementia. MEASUREMENTS: The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference-in-difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends. RESULTS: During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19-1.51), P < .001). No meaningful differences in secondary outcomes were observed. CONCLUSION: Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.
Authors: Jennifer S Temel; Joseph A Greer; Alona Muzikansky; Emily R Gallagher; Sonal Admane; Vicki A Jackson; Constance M Dahlin; Craig D Blinderman; Juliet Jacobsen; William F Pirl; J Andrew Billings; Thomas J Lynch Journal: N Engl J Med Date: 2010-08-19 Impact factor: 91.245
Authors: Laura C Hanson; Christine E Kistler; Kyle Lavin; Stacey L Gabriel; Natalie C Ernecoff; Feng-Chang Lin; Greg A Sachs; Susan L Mitchell Journal: J Pain Symptom Manage Date: 2018-10-18 Impact factor: 3.612
Authors: Joseph W Shega; Gavin W Hougham; Carol B Stocking; Deon Cox-Hayley; Greg A Sachs Journal: J Pain Symptom Manage Date: 2008-02-08 Impact factor: 3.612