Racial disparities in inpatient palliative care consultation among frail older patients undergoing high-risk elective surgical procedures in the United States: a cross-sectional study of the national inpatient sample.

Autor:	Kim KM; Office of Research Patient Care Services, Stanford Health Care, Menlo Park, CA 94025, United States.; Clinical Excellence Research Center, School of Medicine, Stanford University, Palo Alto, CA 94304, United States.; Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA 94143, United States., Muench U; Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA 94143, United States.; Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States., Maki JE; Saint Francis Memorial Hospital, San Francisco, CA 94109, United States., Yefimova M; Center for Nursing Excellence and Innovation, UCSF Health, San Francisco, CA 94143, United States.; Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA 94143, United States., Oh A; Office of Research Patient Care Services, Stanford Health Care, Menlo Park, CA 94025, United States., Jopling JK; Clinical Excellence Research Center, School of Medicine, Stanford University, Palo Alto, CA 94304, United States.; Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, United States., Rinaldo F; Clinical Excellence Research Center, School of Medicine, Stanford University, Palo Alto, CA 94304, United States., Shah NR; Clinical Excellence Research Center, School of Medicine, Stanford University, Palo Alto, CA 94304, United States., Giannitrapani KF; Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, CA 94304, United States.; Quality Improvement Resource Center for Palliative Care, Stanford University, Stanford, CA 94305, United States.; Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA 94305, United States., Williams MY; Office of Research Patient Care Services, Stanford Health Care, Menlo Park, CA 94025, United States.; Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA 94305, United States., Lorenz KA; Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, US Department of Veterans Affairs, Palo Alto, CA 94304, United States.; Quality Improvement Resource Center for Palliative Care, Stanford University, Stanford, CA 94305, United States.; Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA 94305, United States.
Jazyk:	angličtina
Zdroj:	Health affairs scholar [Health Aff Sch] 2023 Jul 13; Vol. 1 (2), pp. qxad026. Date of Electronic Publication: 2023 Jul 13 (Print Publication: 2023).
DOI:	10.1093/haschl/qxad026
Abstrakt:	Surgical interventions are common among seriously ill older patients, with nearly one-third of older Americans facing surgery in their last year of life. Despite the potential benefits of palliative care among older surgical patients undergoing high-risk surgical procedures, palliative care in this population is underutilized and little is known about potential disparities by race/ethnicity and how frailty my affect such disparities. The aim of this study was to examine disparities in palliative care consultations by race/ethnicity and assess whether patients' frailty moderated this association. Drawing on a retrospective cross-sectional study of inpatient surgical episodes using the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2005 to 2019, we found that frail Black patients received palliative care consultations least often, with the largest between-group adjusted difference represented by Black-Asian/Pacific Islander frail patients of 1.6 percentage points, controlling for sociodemographic, comorbidities, hospital characteristics, procedure type, and year. No racial/ethnic difference in the receipt of palliative care consultations was observed among nonfrail patients. These findings suggest that, in order to improve racial/ethnic disparities in frail older patients undergoing high-risk surgical procedures, palliative care consultations should be included as the standard of care in clinical care guidelines. Competing Interests: Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials. Dr. Francesca Rinaldo is an employee and stockholder of Sharecare, Inc. The other authors have no conflicts of interest to declare. (© The Author(s) 2023. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.)
Databáze:	MEDLINE
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