Hospital Mortality Rates: How Is Palliative Care Taken into Account?

Cassel, J. Brian; Jones, Amber; Meier, Diane E.; Smith, Thomas J.; Spragens, Lynn; Weissman, David E.

doi:10.1016/j.jpainsymman.2010.07.005

Cited by 29 publications

(21 citation statements)

References 20 publications

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“…A point prevalence survey in 3 Australian hospitals showed that 35% were classifiable as “requiring a palliative approach” but only 22% of those patients were referred for palliative care – overall, a total of 7.7% . A point prevalence study in Norway showed that 36% of all patients were classified as “palliative” as defined by “advanced, serious, chronic disease with limited life expectancy and symptom relief as the main goal of treatment.” The V66.7 code used in our study is uniformly recognized as the only diagnosis code specifically associated with palliative care, but may be used differently by hospital raters of quality . Regardless of methodology, these data show that the use of palliative care remains low in a disease with a high symptom burden.…”

Section: Discussionmentioning

confidence: 68%

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Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer

2015

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Background Substantial health care resources are used on aggressive end-of-life care, despite an increasing recognition that palliative care improves quality of life and reduces health care costs. We examined the incidence of palliative care encounters in inpatients with incurable head and neck cancer (HNCA) and associations with in-hospital mortality, length of hospitalization, and costs. Methods Data from the Nationwide Inpatient Sample for 80,514 HNCA patients with distant metastatic disease in 2001–2010 was analyzed using cross-tabulations and multivariate regressions. Results Palliative care encounters occurred in 4,029 cases (5%) and were significantly associated with age ≥80 years, female sex, self-pay pay or status, and prior radiation. Palliative care was significantly associated with increased in-hospital mortality and reduced hospital-related costs. Conclusions Inpatient palliative care consultation in terminal HNCA is associated with reduced hospital-related costs, but appears to be underutilized and restricted to the elderly, uninsured, and patients with an increased risk of mortality.

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Section: Discussionmentioning

confidence: 68%

“…34 The V66.7 code used in our study is uniformly recognized as the only diagnosis code specifically associated with palliative care, but may be used differently by hospital raters of quality. 35 Regardless of methodology, these data show that the use of palliative care remains low in a disease with a high symptom burden.…”

Section: Discussionmentioning

confidence: 92%

Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer

2015

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“…The care provided must be aimed only at relieving pain and discomfort for the palliative care code to be applicable”(32). Further clarification regarding the incorporation of palliative care codes by several national healthcare databases has been described by Cassel et al(33). ICD9-CM code V66.7 has previously been shown to accurately identify palliative care services in stroke patients with 81% sensitivity and 97% specificity(5).…”

Section: Methodsmentioning

confidence: 99%

Racial Differences in Palliative Care Use After Stroke in Majority-White, Minority-Serving, and Racially Integrated U.S. Hospitals

Faigle

Ziai

Urrutia

et al. 2017

Critical Care Medicine

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Objective Racial/ethnic differences in palliative care resource use after stroke have been recognized, but it is unclear whether patient or hospital characteristics drive this disparity. We sought to determine whether palliative care use after intracerebral hemorrhage (ICH) and ischemic stroke differs between hospitals serving varying proportions of minority patients. Design Population-based cross-sectional study. Setting Inpatient hospital admissions from the Nationwide Inpatient Sample between 2007 and 2011. Patients A total of 46,735 intracerebral hemorrhage and 331,521 ischemic stroke cases. Interventions Palliative care use. Measurements and Main Results Intracerebral hemorrhage and ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic minority stroke patients (<25% minorities [“white hospitals”], 25–50% minorities [“mixed hospitals”], or >50% minorities [“minority hospitals”]). Logistic regression was used to evaluate the association between race/ethnicity and palliative care use within and between the different hospital strata. Stroke patients receiving care in minority hospitals had lower odds of palliative care compared to those treated in white hospitals, regardless of individual patient race/ethnicity (adjusted odds ratio [OR] 0.65, 95% CI 0.50–0.84 for ICH, and OR 0.62, 95% CI 0.50–0.77 for ischemic stroke). Ethnic minorities had a lower likelihood of receiving palliative care compared to whites in any hospital stratum, but the odds of palliative care for both white and minority ICH patients was lower in minority compared to white hospitals (OR 0.66, 95% CI 0.50–0.87 for white, and OR 0.64, 95% CI 0.46–0.88 for minority patients). Similar results were observed in ischemic stroke. Conclusions The odds of receiving palliative care for both white and minority stroke patients is lower in minority compared to white hospitals, suggesting system-level factors as a major contributor to explain race disparities in palliative care use after stroke.

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“…This code has previously been reported to have high sensitivity and specificity for identifying patients who underwent withdrawal of life-sustaining therapy, 6 but there is concern that its use is not specific for patients who receive specialized palliative care, and that it is largely used to capture the subset of palliative care patients who are actively dying. 7,8 Given the increasing use of this code and prior concerns about its utility, 9,10 we performed a single-center validation study to determine the sensitivity and specificity of the V66.7 code for determining whether hospitalized patients did or did not receive specialized palliative care consultation.…”

Section: Introductionmentioning

confidence: 99%

Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center

Hua

Clancy

et al. 2017

Journal of Palliative Medicine

128

101

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Hospital Mortality Rates: How Is Palliative Care Taken into Account?

Cited by 29 publications

References 20 publications

Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer

Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer

Racial Differences in Palliative Care Use After Stroke in Majority-White, Minority-Serving, and Racially Integrated U.S. Hospitals

Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center

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