Place of death and factors associated with hospital death in patients who have died from liver disease in England: a national population-based study

Peng, Jen‐Kuei; Higginson, Irene J; Gao, Wei

doi:10.1016/s2468-1253(18)30379-0

Cited by 16 publications

(16 citation statements)

References 45 publications

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“…At the end of life, 61%‐78% of patients with DC and 58% of Medicare beneficiaries with HCC not enrolled in hospice die in the hospital. ( 86 , 87 , 88 , 89 , 90 , 91 ) During these long inpatient stays, greater than 50% of patients with AdvLD receive mechanical ventilation, 16% receive dialysis, and 43% receive a blood transfusion, while 28% of patients with HCC use ICU care at the end of life. ( 90 , 92 ) Quality indicators for end‐of‐life care in patients with AdvLD include 1) adequate control of symptoms (pain and dyspnea) and 2) presence of GOC discussions that clarify surrogate decision makers and assure that care received is consistent with the patient’s goals.…”

Section: Resultsmentioning

confidence: 99%

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

et al. 2021

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Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions. (Hepatology Communications 2021;0:1-12).

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Section: Resultsmentioning

confidence: 99%

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

et al. 2021

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“…Consequently, about 70% of the deaths occurred outside hospital. In a real‐world setting, cost saving could be greater as the majority with ESLD would be expected to die in hospital 6,35 . A recent study reported that patients with liver disease were twofold more likely to die in an institution with 15% higher costs ( P < 0.001), compared to those without liver disease 36 .…”

Section: Discussionmentioning

confidence: 99%

“…In a real-world setting, cost saving could be greater as the majority with ESLD would be expected to die in hospital. 6,35 A recent study reported that patients with liver disease were twofold more likely to die in an institution with 15% higher costs (P < 0.001), compared to those without liver disease. 36 Since collection of EQ-5D-5L data were feasible, quality adjusted life years could be calculated in a larger study.…”

Section: Discussionmentioning

confidence: 99%

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Randomised clinical trial: palliative long‐term abdominal drains vs large‐volume paracentesis in refractory ascites due to cirrhosis

Macken¹,

Bremner²,

Gage

et al. 2020

Aliment Pharmacol Ther

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Summary Background Palliative care remains suboptimal in end‐stage liver disease. Aim To inform a definitive study, we assessed palliative long‐term abdominal drains in end‐stage liver disease to determine recruitment, attrition, safety/potential effectiveness, questionnaires/interview uptake/completion and make a preliminary cost comparison. Methods A 12‐week feasibility nonblinded randomised controlled trial comparing large‐volume paracentesis vs long‐term abdominal drains in refractory ascites due to end‐stage liver disease with fortnightly home visits for clinical/questionnaire‐based assessments. Study success criteria were attrition not >50%, <10% long‐term abdominal drain removal due to complications, the long‐term abdominal drain group to spend <50% ascites‐related study time in hospital vs large‐volume paracentesis group and 80% questionnaire/interview uptake/completion. Results Of 59 eligible patients, 36 (61%) were randomised, 17 to long‐term abdominal drain and 19 to large‐volume paracentesis. Following randomisation, median number (IQR) of hospital ascitic drains (long‐term abdominal drain group vs large‐volume paracentesis group) were 0 (0‐1) vs 4 (3‐7); week 12 serum albumin (g/L) and serum creatinine (μmol/L) were 29 (26.5‐32.5) vs 30 (25‐35) and 104.5 (81‐115.5) vs 127 (63‐158) respectively. Total attrition was 42% (long‐term abdominal drain group 47%, large‐volume paracentesis group 37%). Median (IQR) fortnightly community/hospital/social care ascites‐related costs and percentage study time in hospital were lower in the long‐term abdominal drain group, £329 (253‐580) vs £843 (603‐1060) and 0% (0‐0.74) vs 2.75% (2.35‐3.84) respectively. Self‐limiting cellulitis/leakage occurred in 41% (7/17) in the long‐term abdominal drain group vs 11% (2/19) in the large‐volume paracentesis group; peritonitis incidence was 6% (1/17) vs 11% (2/19) respectively. Questionnaires/interview uptake/completion were ≥80%; interviews indicated that long‐term abdominal drains could transform the care pathway. Conclusions The REDUCe study demonstrates feasibility with preliminary evidence of long‐term abdominal drain acceptability/effectiveness/safety and reduction in health resource utilisation. Trial registration: ISRCTN30697116, date assigned: 07/10/2015.

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“…The NCEPOD review only reported “established renal failure at presentation,” but this was highly prevalent at 30% for those dying during admission (vs 66% with codes for acute kidney injury among deaths in our study). A recent study of people who died from liver disease in England identified renal complications as strongly associated with hospital death 29 …”

Section: Discussionmentioning

confidence: 99%

Reducing variation in hospital mortality for alcohol‐related liver disease in North West England

Kallis

Dixon

Silberberg

et al. 2020

Aliment Pharmacol Ther

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Summary Background Variations in emergency care quality for alcohol‐related liver disease (ARLD) have been highlighted. Aim To determine whether introduction of a regional quality improvement (QI) programme was associated with a reduction in potentially avoidable inpatient mortality. Method Retrospective observational cohort study using hospital administrative data spanning a 1‐year period before (2014/2015) and 3 years after a QI initiative at seven acute hospitals in North West England. The intervention included serial audit of a bundle of process metrics. An algorithm was developed to identify index (“first”) emergency admissions for ARLD (n = 3887). We created a standardised mortality ratio (SMR) to compare relative mortality and regression models to examine risk‐adjusted odds of death. Results In 2014/2015, three of seven hospitals had an SMR above the upper control limit (“outliers”). Adjusted odds of death for patients admitted to outlier hospitals was higher than non‐outliers (OR 2.13, 95% CI 1.32‐3.44, P = 0.002). Following the QI programme there was a step‐wise reduction in outliers (none in 2017/2018). Odds of death was 67% lower in 2017/2018 compared to 2014/2015 at original outlier hospitals, but unchanged at other hospitals. Process audit performance of outliers was worse than non‐outliers at baseline, but improved after intervention. Conclusions There was a reduction in unexplained variation in hospital mortality following the QI intervention. This challenges the pessimism that is prevalent for achieving better outcomes for patients with ARLD. Notwithstanding the limitations of an uncontrolled observational study, these data provide hope that co‐ordinated efforts to drive adoption of evidence‐based practice can save lives.

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Place of death and factors associated with hospital death in patients who have died from liver disease in England: a national population-based study

Cited by 16 publications

References 45 publications

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

Randomised clinical trial: palliative long‐term abdominal drains vs large‐volume paracentesis in refractory ascites due to cirrhosis

Reducing variation in hospital mortality for alcohol‐related liver disease in North West England

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