Effects of Advanced Care Planning on Reduced Mortality, Implications of Blood Transfusion Use by ICU sites, and Further Statistical Considerations

Ukken, Johnson; Froehlich, Mary; Kioka, Mutsumi; Romero, Arthur Oliver; Lee, Yong Jae; Liu, Xibei; Liu, Caroline; Yoo, Ji Won

doi:10.1016/j.chest.2017.09.050

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…These findings are consistent with recent report concluding that percutaneous gastrostomy tube feeding might not improve survival or aspiration pneumonia risk in patients with swallowing disturbances. 25,26 Palliative care consultation utilization substantially increased among patients with advanced chronic illnesses such as chronic obstructive pulmonary disease and chronic liver disease. 15,27,28 The advantages of palliative care consultation account for improving health-care efficiency by reducing health expenditures resulting from reduced in-hospital deaths in patients with advanced cancer in acute hospital setting.…”

Section: Discussionmentioning

confidence: 99%

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Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014

et al. 2019

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Aim: Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined. Methods and Materials: A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ2 statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation. Results: Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were −4.19% ( P = .008), 2.17%, −1.40%, and 14.03% ( P < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation ( Ps < .001). Conclusions: Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014

et al. 2019

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“…Another explanation for our findings could be that male and racial/ethnic minority groups might underutilize hospice and palliative care services, a type of care that lower hospital LOS, charges, and mortality. Previous studies have indicated that male and racial/ethnic minority groups are less proactive about choosing a hospital palliative care referral or enrolling in hospice when their medical care is futile, potentially leading to longer hospital LOS and higher hospital charges and mortality rates (23,29,30). This mechanism is also applied to the Medicaid recipients (29).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have indicated that male and racial/ethnic minority groups are less proactive about choosing a hospital palliative care referral or enrolling in hospice when their medical care is futile, potentially leading to longer hospital LOS and higher hospital charges and mortality rates (23,29,30). This mechanism is also applied to the Medicaid recipients (29). The findings of our study are consistent with previous studies showing that race and ethnicity are related to hospital outcomes (17,30), but Asian populations were the most vulnerable race/ethnicity in Nevada in terms of hospitalization with respiratory conditions.…”

Section: Discussionmentioning

confidence: 99%

Changes in characteristics of inpatient respiratory conditions from 2019 to 2021 (before and during the COVID-19 pandemic)

Mojtahedi,

Yoo,

Kim

et al. 2023

Front. Public Health

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BackgroundThe COVID-19 pandemic has resulted in an increase in the number of individuals with respiratory conditions that require hospitalization, posing new challenges for the healthcare system. Recent respiratory condition studies have been focused on the COVID-19 period, with no comparison of respiratory conditions before and during the pandemic. This study aimed to examine hospital-setting respiratory conditions regarding potential changes in length of stay (LOS), mortality, and total charge, as well as socioeconomic disparities before and during the pandemic.MethodsThe study employed a pooled cross-sectional design based on the State Inpatient Data Nevada for 2019 (prior to the COVID-19 pandemic) and 2020–2021 (during the pandemic) and investigated all respiratory conditions, identified by the International Classification of Disease, 10th Revision codes (n = 227,338). Descriptive analyses were carried out for the three years. Generalized linear regression models were used for multivariable analyses. Outcome measures were hospital LOS, mortality, and total charges.ResultsA total of 227,338 hospitalizations with a respiratory condition were included. Hospitalizations with a respiratory condition increased from 65,896 in 2019 to 80,423 in 2020 and 81,018 in 2021. The average LOS also increased from 7.9 days in 2019 to 8.8 days in 2020 but decreased to 8.1 days in 2021; hospital mortality among patients with respiratory conditions increased from 7.7% in 2019 to 10.2% but decreased to 9.6% in 2021; and the total charges per discharge were $159,119, $162,151, and $161,733 from 2019 to 2021, respectively (after adjustment for the inflation rate). Hispanic, Asian, and other race patients with respiratory conditions were 1–3 times more likely than white patients to have higher mortality and LOS. Medicaid patients and non-White patients were predictors of a higher respiratory-related hospital total charge.ConclusionDemographic and socioeconomic factors were significantly associated with respiratory-related hospital utilization in terms of LOS, mortality, and total charge.

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Impact of an Electronic Medical Record Alert on Code Status Documentation for Hospitalized Patients With Advanced Cancer

Switzer

Jazieh

Bernstein

et al. 2020

JCO Oncology Practice

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PURPOSE: Cardiopulmonary resuscitation in hospitalized patients with advanced cancer is associated with high rates of morbidity and mortality. Although advance care planning (ACP) in this population improves quality, patient satisfaction, hospice use, rates of harm, and health care costs, ACP documentation rates remain low. We observed changes in ACP documentation by internal medicine residents within a tertiary hospital’s inpatient oncology service after a mandatory training module and enterprise-wide modification in electronic health medical records (EHMR). METHODS: For patients admitted to the Cleveland Clinic oncology service, this 16-week retrospective review observed resident code status (CS) documentation through admission notes and direct EHMR orders before and after implementation of an ACP training module and CS best practice alert (BPA). In addition, residents were surveyed on perceived barriers to CS documentation. RESULTS: In 535 unique admissions (244 before BPA, 291 after BPA), residents exhibited a 14.4% increase (from 47.1% to 61.5%) in admission note CS documentation and an 18.2% increase (from 12.7% to 30.9%) in CS orders at time of discharge. The most common self-reported barrier to ACP documentation was forgetting to discuss, with first-, second-, and third-year residents admitting to feeling uncomfortable in orchestrating ACP conversations at rates of 58%, 6%, and 5%, respectively. CONCLUSION: Resident ACP documentation remains suboptimal in the high-risk cohort of hospitalized patients with advanced cancer. However, rates seem to be positively influenced by online modules and EHMR-based interventions. Additional efforts to improve the current practice and culture of ACP remain a crucial aspect in the quality and safety of our approach to patient care.

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Effects of Advanced Care Planning on Reduced Mortality, Implications of Blood Transfusion Use by ICU sites, and Further Statistical Considerations

Cited by 3 publications

References 7 publications

Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014

Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014

Changes in characteristics of inpatient respiratory conditions from 2019 to 2021 (before and during the COVID-19 pandemic)

Impact of an Electronic Medical Record Alert on Code Status Documentation for Hospitalized Patients With Advanced Cancer

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