Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs*
Autor: | Meeta Prasad Kerlin, Alisa J. Stephens-Shields, Deepshikha Charan Ashana, Yong Chen, Craig A Umscheid, Michael O. Harhay, Vanessa Madden, Rachel Kohn |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male medicine.medical_specialty Palliative care Adolescent medicine.medical_treatment Psychological intervention Critical Care and Intensive Care Medicine Health Services Accessibility Cohort Studies Young Adult 03 medical and health sciences 0302 clinical medicine Clinical Protocols Humans Medicine Hospital Mortality Cardiopulmonary resuscitation Referral and Consultation Aged Retrospective Studies Withholding Treatment business.industry Palliative Care Hospices 030208 emergency & critical care medicine Retrospective cohort study Odds ratio Middle Aged Pennsylvania Patient Discharge Intensive Care Units 030228 respiratory system Emergency medicine Female business End-of-life care Cohort study |
Zdroj: | Critical Care Medicine. 47:1591-1598 |
ISSN: | 0090-3493 |
Popis: | Objectives As ICUs are increasingly a site of end-of-life care, many have adopted end-of-life care resources. We sought to determine the association of such resources with outcomes of ICU patients. Design Retrospective cohort study. Setting Pennsylvania ICUs. Patients Medicare fee-for-service beneficiaries. Interventions Availability of any of one hospital-based resource (palliative care consultants) or four ICU-based resources (protocol for withdrawal of life-sustaining therapy, triggers for automated palliative care consultation, protocol for family meetings, and palliative care clinicians embedded in ICU rounds). Measurements and main results In mixed-effects regression analyses, admission to a hospital with end-of-life resources was not associated with mortality, length of stay, or treatment intensity (mechanical ventilation, hemodialysis, tracheostomy, gastrostomy, artificial nutrition, or cardiopulmonary resuscitation); however, it was associated with a higher likelihood of discharge to hospice (odds ratio, 1.58; 95% CI, 1.11-2.24), an effect that was driven by ICU-based resources (odds ratio, 1.37; 95% CI, 1.04-1.81) rather than hospital-based resources (odds ratio, 1.19; 95% CI, 0.83-1.71). Instrumental variable analysis using differential distance (defined as the additional travel distance beyond the hospital closest to a patient's home needed to reach a hospital with end-of-life resources) demonstrated that among those for whom differential distance would influence receipt of end-of-life resources, admission to a hospital with such resources was not associated with any outcome. Conclusions ICU-based end-of-life care resources do not appear to change mortality but are associated with increased hospice utilization. Given that this finding was not confirmed by the instrumental variable analysis, future studies should attempt to verify this finding, and identify specific resources or processes of care that impact the care of ICU patients at the end of life. |
Databáze: | OpenAIRE |
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