Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19.

Autor: Kiker WA; Division of Pulmonary, Critical Care and Sleep Medicine (W.A.K., L.R.P., E.K.K., J.R.C., ), University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence (WA.K., L.R.P., C.J.C., E.K.K., J.R.C., N.K.), University of Washington, Seattle, WA, USA. Electronic address: wkiker@uw.edu., Cheng S; Department of Biostatistics (S.C.), University of Washington, Seattle, WA, USA., Pollack LR; Division of Pulmonary, Critical Care and Sleep Medicine (W.A.K., L.R.P., E.K.K., J.R.C., ), University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence (WA.K., L.R.P., C.J.C., E.K.K., J.R.C., N.K.), University of Washington, Seattle, WA, USA., Creutzfeldt CJ; Cambia Palliative Care Center of Excellence (WA.K., L.R.P., C.J.C., E.K.K., J.R.C., N.K.), University of Washington, Seattle, WA, USA; Department of Neurology, Harborview Medical Center (C.J.C.), University of Washington, Seattle, WA, USA., Kross EK; Division of Pulmonary, Critical Care and Sleep Medicine (W.A.K., L.R.P., E.K.K., J.R.C., ), University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence (WA.K., L.R.P., C.J.C., E.K.K., J.R.C., N.K.), University of Washington, Seattle, WA, USA., Curtis JR; Division of Pulmonary, Critical Care and Sleep Medicine (W.A.K., L.R.P., E.K.K., J.R.C., ), University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence (WA.K., L.R.P., C.J.C., E.K.K., J.R.C., N.K.), University of Washington, Seattle, WA, USA., Belden KA; Division of Infectious Diseases (K.A.B.), Thomas Jefferson University Hospital, Philadelphia, PA, USA., Melamed R; Abbott Northwestern Hospital (R.M.), Allina Health, Minneapolis, MN, USA., Armaignac DL; Center for Advanced Analytics (D.L.A.), Baptist Health South Florida, Miami, FL, USA., Heavner SF; Department of Public Health Sciences (S.F.H.), Clemson University, Clemson, SC, USA., Christie AB; Department of Critical Care (A.B.C.), Atrium Health Navicent, Macon, GA, USA., Banner-Goodspeed VM; Department of Anesthesia, Critical Care & Pain Medicine (V.M.B-G.), Beth Israel Deaconess Medical Center, Boston, MA, USA., Khanna AK; Department of Anesthesiology, Section on Critical Care Medicine (A.K.K.), Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA; Outcomes Research Consortium (A.K.K.), Cleveland, OH, USA., Sili U; Department of Infectious Diseases and Clinical Microbiology, School of Medicine (U.S.), Marmara University, Istanbul, Turkey., Anderson HL 3rd; Department of Surgery (H.L.A.), St Joseph Mercy Ann Arbor, Ann Arbor, MI, USA., Kumar V; Society of Critical Medicine (V.K.), Mount Prospect, IL, USA., Walkey A; The Pulmonary Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and Evans Center of Implementation and Improvement Sciences, Department of Medicine (A.W.), Boston University School of Medicine, Boston, MA, USA., Kashyap R; Division of Pulmonary and Critical Care Medicine (R.K., O.G.), Mayo Clinic, Rochester, MN, USA., Gajic O; Division of Pulmonary and Critical Care Medicine (R.K., O.G.), Mayo Clinic, Rochester, MN, USA., Domecq JP; Division of Nephrology and Hypertension (J.P.D.), Mayo Clinic, Rochester, MN, USA; Department of Critical Care Medicine (J.P.D.), Mayo Clinic, Mankato, MN, USA., Khandelwal N; Cambia Palliative Care Center of Excellence (WA.K., L.R.P., C.J.C., E.K.K., J.R.C., N.K.), University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine (N.K.), University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2022 Oct; Vol. 64 (4), pp. 359-369. Date of Electronic Publication: 2022 Jun 25.
DOI: 10.1016/j.jpainsymman.2022.06.014
Abstrakt: Context: The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19.
Objectives: Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measures-only orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19.
Methods: This cross-sectional study examined data from an international registry of hospitalized patients with COVID-19. A proportional odds model evaluated predictors of more aggressive code status (i.e., Full Code) vs. less (i.e., Do Not Resuscitate, DNR). Among decedents, logistic regression was used to identify predictors of palliative care consultation, comfort measures only, and CPR at time of death.
Results: We included 29,923 patients across 179 sites. Among those with admission code status documented, Full Code was selected by 90% (n = 15,273). Adjusting for site, Full Code was more likely for patients who were of Black or Asian race (ORs 1.82, 95% CIs 1.5-2.19; 1.78, 1.15-3.09 respectively, relative to White race), Hispanic ethnicity (OR 1.89, CI 1.35-2.32), and male sex (OR 1.16, CI 1.0-1.33). Of the 4951 decedents, 29% received palliative care consultation, 59% transitioned to comfort measures only, and 29% received CPR, with non-White racial and ethnic groups less likely to receive comfort measures only and more likely to receive CPR.
Conclusion: In this international cohort of patients with COVID-19, Full Code was the initial code status in the majority, and more likely among patients who were Black or Asian race, Hispanic ethnicity or male. These results provide direction for future studies to improve these disparities in care.
(Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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