Trends in Hospital-Based Specialty Palliative Care in the United States From 2013 to 2017
| Autor: | Angela K. Marks, David L. O'Riordan, Laura Schoenherr, Steven Z. Pantilat, Kara Bischoff |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Advance care planning
Male medicine.medical_specialty Quality management Palliative care Specialty MEDLINE Medicine Humans Medical diagnosis Original Investigation Aged Quality of Health Care Retrospective Studies Aged 80 and over Patient Care Team business.industry Research Health Policy Palliative Care Retrospective cohort study General Medicine Odds ratio Middle Aged Quality Improvement Patient Discharge United States Online Only Family medicine Female business Delivery of Health Care |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | This cohort study characterizes current practice and trends among patients cared for and outcomes achieved by inpatient specialty palliative care services in the United States. Key Points Question How have the practice and outcomes of inpatient, specialty palliative care in the United States changed over time? Findings During the 5 years examined in this cohort study of 135 197 patients, palliative care teams saw an increasing percentage of patients with diagnoses other than cancer, saw an increasing percentage of patients discharged from the hospital alive, and connected more patients with outpatient supportive services. Meaning These trends suggest that inpatient palliative care teams are reaching a broader group of patients with serious illness and are seeing them earlier in their illnesses, consistent with emerging data and guidelines. Importance Although palliative care (PC) historically focused on patients with cancer and those near the end of life, evidence increasingly demonstrates a benefit to patients with a broad range of serious illnesses and to those earlier in their illness. The field of PC has expanded and evolved rapidly, resulting in a need to characterize practice over time to understand whether it reflects evolving evidence and guidelines. Objective To characterize current practice and trends among patients cared for and outcomes achieved by inpatient specialty PC services in the United States. Design, Setting, and Participants This retrospective cohort study was performed from January 1, 2013, to December 31, 2017, at 88 US hospitals in which PC teams voluntarily participate in the Palliative Care Quality Network (PCQN), a national quality improvement collaborative. A total of 135 197 patients were referred to PCQN teams during the study period. Initial analyses of the study data were conducted from March 3 to March 21, 2018. Exposure Inpatient PC consultation. Main Outcomes and Measures A total of 23 standardized data elements collected by PCQN teams that provided information about the characteristics of referred patients, including age, sex, Palliative Performance Scale score, and primary diagnosis leading to PC consult; reason(s) given for the consultation; and processes of care provided by the PC team, including disciplines involved, number of family meetings held, advance care planning documentation completed, and screened for and intervened on needs. Results A total of 135 197 patients were referred to inpatient PC (51.0% female; mean age, 71.3 years [range, 57.8-82.5 years]) and were significantly debilitated (mean Palliative Performance Scale score, 34.7%; range, 14.9%-56.8%). Cancer was the most common primary diagnosis (32.0%; range, 11.3%-93.9%), although rates decreased from 2013 to 2017 (odds ratio [OR], 0.84; 95% CI, 0.79-0.91; P |
| Databáze: | OpenAIRE |
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