A retrospective study on use of palliative care for patients with alcohol related end stage liver disease in United States

Abstract

BACKGROUND Palliative care (PC) has been shown to be beneficial in end stage liver disease (ESLD), yet the hospitalization data for PC utilization is unknown. AIM To identify the trend of PC utilization for the special population of alcohol-associated ESLD patients, factors affecting its use and ascertain its impact on healthcare utilization. METHODS We analyzed around 78 million discharges from the 2007-2014 national inpatient sample and 2010-2014 national readmission database including adult patients admitted for decompensated alcohol-associated cirrhosis. We identified patients with PC consultation as a secondary diagnosis. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS Out of the total 1421849 hospitalizations for decompensated liver cirrhosis, 62782 (4.4%) hospitalizations had a PC consult, which increased from 0.8% (1258) of all alcohol-associated ESLD hospitalizations in 2007 to 6.6% in 2014 ( P < 0.01). Patient and hospital characteristics associated with increased odds of PC utilization were advanced age, lower income, Medicaid coverage, teaching institution, urban location, length of stay > 3 d, prolonged ventilation, and administration of total parenteral nutrition (all P < 0.01). Palliative encounters in alcohol-associated ESLD and acute-on-chronic liver failure (ACLF) score were associated with increased odds of discharge to a rehabilitation facility, but significantly lower odds of 30-d readmissions (aOR: 0.35, 95%CI: 0.31-0.41), lower total hospitalization charges and lower mean hospitalization days (all P < 0.01). CONCLUSION Inpatient PC is sparingly used for patients with decompensated alcohol related liver disease, however it has increased over the past decade. PC consultation is associated with lower 30-d readmission rates on multivariate analysis, and lower hospitalization cost and length of stay in patients with ACLF score ≥ 2.

Impact of Palliative Care Utilization among Kidney Cancer Patients in US Hospitals: A National-Scale Analysis

“…Our findings demonstrated that palliative care use increased during the study periods, which was consistent with earlier research on palliative care utilization in other chronic conditions. For example, a prior study discovered a 0.8-6.6% increase in all alcohol-associated end-stage liver disease hospitalized patients between 2007 and 2014 (22). Another retrospective study that implemented NIS determined that between 2005 and 2014, the proportion of patients with chronic obstructive pulmonary disease (COPD) receiving palliative care increased from 8.5% to 57.2% (23).…”

GITalk: Communication Skills Training for Gastroenterology Fellows Improves Self-Assessed Preparedness for Serious Illness Conversations

“…[6,7] Communication around treatment decisions are often delayed and tend to take place in the inpatient setting, where mortality is high, especially in conditions such as decompensated cirrhosis. [8][9][10][11] One reason for such delayed and limited communication in this high-risk population may be gaps in training for general and subspecialty gastroenterology (GI) fellows. Prior studies have demonstrated low quality of communication among GI fellows when discussing end-of-life care.…”