Surgical Versus Medical Team Assignment and Secondary Palliative Care Services for Patients Dying in a Cardiac Hospital
| Autor: | Laura Hoeksema, Silvia Perez Protto, Benjamin Gandesbery, Emer Joyce, Krista Dobbie, Eiran Z. Gorodeski |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Palliative care Cardiac Care Facilities Population Certification Disease Subspecialty 03 medical and health sciences 0302 clinical medicine Sex Factors 030502 gerontology medicine Humans education Intensive care medicine Hospice care Specialist palliative care Aged Retrospective Studies Patient Care Team education.field_of_study Inpatients business.industry Palliative Care Age Factors General Medicine Middle Aged medicine.disease Hospice Care Logistic Models Socioeconomic Factors Cardiovascular Diseases 030220 oncology & carcinogenesis Medical team Medical emergency 0305 other medical science Cardiology and Cardiovascular Medicine business |
| Zdroj: | The American journal of hospicepalliative care. 36(4) |
| ISSN: | 1938-2715 |
| Popis: | Background: Secondary palliative care (SPC) provides several benefits for patients with cardiovascular disease, but historically, it has been underutilized in this population. Prior research suggests a low rate of SPC consultation by surgical teams in general, but little is known about how surgical teams utilize SPC in the setting of severe cardiovascular disease. Aim: To determine if surgical team assignment affects the probability of SPC for inpatients dying of cardiovascular disease. Design: Retrospective, cohort study. Methods: We identified all inpatients at a large cardiac hospital who had anticipated death under the care of a cardiology, cardiac surgery, or vascular surgery team in 2016. Our primary outcome was referral to SPC, including palliative medicine consultation or inpatient hospice care. Informed by univariate analysis, we created a multivariable logistic regression model, the significance of which was assessed with the Wald test. Results: Two hundred thirty-seven patients were included in our analysis: 93 (39%) received SPC and 144 (61%) were “missed opportunities.” Secondary palliative care was less frequent in patients assigned to a surgical, versus medical, team (11% vs 47%, P < .001). On multivariate analysis, surgical versus medical team assignment was the strongest risk-adjusted predictor of SPC (odds ratio [OR]: 0.10, P < .001). Other predictors of SPC included do not resuscitate status on admission (OR: 14, P < .001), length of stay (OR = 1.05/day, P < .001), and having Medicare (OR = 3.9, P = .002). Conclusions: Primary inpatient care by a surgical team had a strong inverse relationship with SPC. This suggests a possible cultural barrier within surgical disciplines to SPC. |
| Databáze: | OpenAIRE |
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