Factors Associated with Inpatient Hospice Utilization among Hospitalized Decedents with Comfort Measures Only Status
- 30 January 2023
- journal article
- research article
- Published by Mary Ann Liebert Inc in Journal of Palliative Medicine
- Vol. 26 (8), 1048-1055
- https://doi.org/10.1089/jpm.2022.0460
Abstract
Background: Patients with serious illness may elect to transition their care to comfort measures only (CMO) while in the hospital. Although studies have shown that routine hospice care is underutilized, the rate of general inpatient hospice (GIP) use among CMO patients during their terminal admission remains unclear. Objectives: We sought to (1) examine the rate of GIP utilization and (2) identify factors associated with its use among hospitalized CMO decedents. Methods: CMO decedents in two academic, tertiary care hospitals in the United States who died between October 1, 2020 and October 31, 2021, were subgrouped based on their primary medical service (GIP vs. non-GIP) at the time of inpatient death. Data abstracted from the electronic health record included demographics, primary diagnosis codes, Rothman Index (RI), time of CMO order, ordering clinician type, time of death, and length of stay (LOS). Multivariable logistic regression analysis was performed, adjusting for relevant covariates. Results: Of 1475 CMO decedents, only 321 (n = 22%) patients received GIP. On multivariable analysis, CMO patients who died in an ICU were five times less likely (odds ratio [OR] = 0.18, confidence interval [95% CI] 0.11–0.29) to receive GIP. Every 10-point increase in RI raised the likelihood of receiving GIP by 59% (OR = 1.59, 95% CI 1.39–1.80). Conclusions: Most CMO decedents died in the hospital without GIP. Compared with GIP decedents, non-GIP decedents were less acutely ill. There was no difference in total LOS between the two groups. CMO decedents were much less likely to receive GIP in an ICU. The RI may help clinicians identify CMO patients who would benefit from GIP earlier in their terminal admission.Keywords
This publication has 29 references indexed in Scilit:
- Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: A retrospective cohort design of 2002–2012Palliative Medicine, 2015
- The impact of hospice care on survival and cost saving among patients with liver cancer: a national longitudinal population-based study in TaiwanSupportive Care in Cancer, 2014
- Hospice Agencies’ Hospital Contract Status and Differing Levels of Hospice CareAmerican Journal of Hospice and Palliative Medicine®, 2014
- Shared decision-making at end-of-life is aided by graphical trending of illness severityBMJ Case Reports, 2014
- Development and validation of a continuous measure of patient condition using the Electronic Medical RecordJournal of Biomedical Informatics, 2013
- Hospice eligibility in patients who died in a tertiary care centerJournal of Hospital Medicine, 2011
- Place of Death: Correlations With Quality of Life of Patients With Cancer and Predictors of Bereaved Caregivers' Mental HealthJournal of Clinical Oncology, 2010
- Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year WindowJournal of Pain and Symptom Management, 2007
- Quality of Dying in the ICUSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2005
- A Multi-institutional Study of Care Given to Patients Dying in HospitalsArchives of Internal Medicine, 1996