Demographics, Resource Utilization, and Outcomes of Elderly Patients With Chronic Liver Disease Receiving Hospice Care in the United States
| Autor: | Zobair M. Younossi, Pegah Golabi, Chapy Venkatesan, Alita Mishra, Natsu Fukui, Munkhzul Otgonsuren |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Demographics Medicare Chronic liver disease Patient Readmission 03 medical and health sciences Age Distribution 0302 clinical medicine Non-alcoholic Fatty Liver Disease Odds Ratio medicine Humans Sex Distribution Intensive care medicine Liver Diseases Alcoholic Hospice care Aged Aged 80 and over Heart Failure Hepatology business.industry Liver Diseases Gastroenterology Health Care Costs social sciences Hepatitis C Chronic Length of Stay Middle Aged medicine.disease United States humanities Hospitalization Hospice Care Logistic Models 030220 oncology & carcinogenesis Chronic Disease Linear Models Female 030211 gastroenterology & hepatology business Resource utilization |
| Zdroj: | American Journal of Gastroenterology. 112:1700-1708 |
| ISSN: | 0002-9270 |
| DOI: | 10.1038/ajg.2017.290 |
| Popis: | Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice.Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals.A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all P0.001). Presence of HCV and congestive heart failure were the strongest contributors to increased total annual costs (34% and 31% higher, P0.001), increased total annual LOS (26% and 43% higher, P0.001), and increased 30-day readmission risk (2.20 and 2.19 times, respectively).Patients with CLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice. |
| Databáze: | OpenAIRE |
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