End-of-Life Spending and Healthcare Utilization Among Older Adults with Chronic Obstructive Pulmonary Disease

Iyer, Anand S; Goodrich, Christine A.; Alam, Shama S.; Brown, Cynthia J.; Landefeld, C. Seth; Bakitas, Marie; Brown, Jeremiah R.

doi:10.1016/j.amjmed.2019.11.024

Cited by 18 publications

(8 citation statements)

References 37 publications

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“…[37][38][39][40][41] Recent studies investigating PD and EOL care focus predominately on the provision and/or indicators of quality palliative and/or EOL care, physical symptomology and management, and factors related to the healthcare spending and utilization of palliative and/or EOL care. [42][43][44][45][46] This study supports the relationship between pain and SD as identified in previous studies with similar populations, yet findings contrast with previous research in which prevalence of pain 5,7-9,47 and SD 10,11,14,22,23 is higher. Interpretation must be viewed with caution since measures for SD varied among previous research, nonetheless findings are supported by studies of similar populations.…”

Section: Discussionsupporting

confidence: 83%

“…For example, PD are typically chronic, highly symptomatic at EOL, and may result from lifestyle choices, such as smoking. 37,39,45,46 Perhaps these factors contribute to the increased risk for experiencing SD and other elements of the total pain experience at EOL. Investigation of the nature and variance within each diagnosis category may also be warranted.…”

Section: Discussionmentioning

confidence: 99%

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Pain and Spiritual Distress at End of Life: A Correlational Study

2022

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Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age ( t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Pain and Spiritual Distress at End of Life: A Correlational Study

2022

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“…Significance tests were performed across multiple categories to limit multiple testing and false positives. Additionally, given that there are substantial HRR-level differences in care patterns at the EOL, [25][26][27] we explored whether HRR-level utilization of hospice and home health care is associated with total HDAH. Additionally, to evaluate the degree to which home-based services such as home health and home hospice can substitute for acute and postacute care and maximize total HDAH, we calculated Spearman correlation coefficients for the patientand HRR-level associations between the use of home hospice days and home health and total HDAH and its components.…”

Section: Discussionmentioning

confidence: 99%

Healthy days at home: A population‐based quality measure for cancer patients at the end of life

Lam

Riley

Zheng

et al. 2021

Cancer

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BACKGROUND: Healthy Days at Home (HDAH) is a novel population-based outcome measure. In this study, its use as a potential measure for cancer patients at the end of life (EOL) was explored. METHODS: Patient demographics and health care use among Medicare beneficiaries with cancer who died over the years 2014 to 2017 were identified. The HDAH was calculated by subtracting the following components from 180 days: number of days spent in inpatient and outpatient hospital observation, the emergency room, skilled nursing facilities (SNF), inpatient psychiatry, inpatient rehabilitation, long-term hospitals, and inpatient hospice. How HDAH and its components varied by beneficiary demographics and health care market were evaluated. A patient-level linear regression model with HDAH as the outcome, hospital referral region (HRR) random effects, and market fixed effects were specified, as well as beneficiary age, sex, and comorbidities as covariates. RESULTS: The 294,751 beneficiaries at the EOL showed a mean number of 154.0 HDAH (out of 180 days). Inpatient (10.7 days) and SNF (9.7 days) resulted in the most substantial reductions in HDAH. Males had fewer adjusted HDAH (153.1 vs 155.7, P < .001) than females; Medicaid-eligible patients had fewer HDAH compared with non-Medicaid-eligible patients (152.0 vs 154.9; P < .001). Those with hematologic malignancies had the fewest number of HDAH (148.9). Across HRRs, HDAH ranged from 10.8 fewer to 10.9 more days than the national mean. At the HRR-level, home hospice was associated with greater HDAH, whereas home health was associated with fewer HDAH. CONCLUSIONS: HDAH may be a useful measure to understand, quantify, and improve patient-centered outcomes for cancer patients at EOL.

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“… 1 Currently, COPD is the fourth leading cause of death worldwide and imposes a heavy economic burden on sufferers. 2 …”

Section: Introductionmentioning

confidence: 99%

“…1 Currently, COPD is the fourth leading cause of death worldwide and imposes a heavy economic burden on sufferers. 2 The main organ involved in COPD is the pulmonary tissue, and its causes may be attributed to chronic tissue inflammation and long-term hypoxia. The extra-pulmonary comorbidities of COPD have been gaining attention and recent studies have suggested a possible association between COPD and renal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Correlation Analysis of Early Renal Injury in Elderly Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Zhang¹

2022

COPD

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Objective To investigate the correlation between serum cystatin C (Cys-C) and beta-2 (β2) microglobulin (β2-MG) levels and renal injury in elderly patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with a view to detecting renal injury in its early stages. Methods A total of 106 patients with AECOPD were enrolled and divided into three groups according to their oxygen partial pressure (PO 2 ) levels: severe hypoxia group, moderate hypoxia group, and mild hypoxia group. Another 60 healthy subjects were selected as the control group. General clinical data were collected from all the study subjects, along with measurements of arterial blood gas, Cys-C, β2-MG, serum creatinine (Scr), urea nitrogen (BUN), partial pressure of carbon dioxide (PCO 2 ), and high-sensitivity C-reactive protein (hs-CRP). Results The levels of hs-CRP, Cys-C, β2-MG, Scr, and BUN were highest in the severe hypoxia group, followed by the moderate hypoxia group, then the mild hypoxia group, and lowest in the control group. The differences between the groups were statistically significant for these indicators (P < 0.05). Apart from in the cases of Scr and BUN, there were no statistically significant differences between the mild group and the control group (P > 0.05). The levels of Cys-C and β2-MG were positively correlated with the levels of hs-CRP, PCO 2 , Scr, and BUN and negatively correlated with PO 2 levels. hs-CRP and PO 2 were high-risk factors influencing Cys-C levels, and β2-MG was a risk factor influencing Cys-C levels. The level of PO 2 was a high-risk factor influencing β2-MG levels, and PCO 2 and Cys-C were risk factors influencing β2-MG levels. Conclusion Renal injury was found to be present in patients with AECOPD and worsened with increasing degrees of hypoxia. Hypoxia and inflammation might be risk factors for renal injury in patients with AECOPD, Cys-C and β2-MG could be sensitive indicators for the early detection of renal injury.

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End-of-Life Spending and Healthcare Utilization Among Older Adults with Chronic Obstructive Pulmonary Disease

Cited by 18 publications

References 37 publications

Pain and Spiritual Distress at End of Life: A Correlational Study

Pain and Spiritual Distress at End of Life: A Correlational Study

Healthy days at home: A population‐based quality measure for cancer patients at the end of life

Correlation Analysis of Early Renal Injury in Elderly Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

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