Relationships among advance directives, principal diagnoses, and discharge outcomes in critically ill older adults

Abstract

Significantly fewer in-hospital deaths in addition to higher hospice discharges were observed with any advance directives in community-dwelling, critically ill older adults. The magnitude of these findings was aggregated when their principal diagnoses were a group of diseases with more difficult prognostication (circulatory and respiratory diseases) and more potential for reversibility (infectious diseases). By contrast, the magnitude of these findings was diminished with other principal diagnoses.

Ten-Year Trends of Utilization of Palliative Care Services and Life-Sustaining Treatments and Hospital Costs Associated With Patients With Terminally Ill Lung Cancer in the United States From 2005 to 2014

“…However, we speculate that the lack of documentation and/or communication could be the leading reason for choosing LSTs among dying patients with cancer in previous studies. 19,33,41,45 To the best of our knowledge, our study is the first report a 10-year national utilization trend analysis of palliative care services and LSTs and their effects on hospital costs among dying patients with lung cancer. Given the largest data set and 10-year study period, we believe that secular trends in our study are likely generalizable to most US dying patients with lung cancer.…”

Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014

“…33 These associations between utilizing life-sustaining procedures and palliative care consultation could also be correlated with overdue referral for hospital-based palliative consultation or hospice as observed in previous studies. 15,20,[34][35][36] Lifesustaining procedures are often initiated until the goals of care are firmly established by patient or health-care proxy. Challenges for timely referral to hospital palliative care consultation include lack of EOL communication, patients' preferences of EOL, and lack of continuity of care between primary care provider/oncologist and hospitalist.…”

Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis

“…directly contacted the authors of those studies to obtain them. Finally, 11 studies were selected for analysis with respect to hospital LOS (Ahrens et al, 2003; Cox et al, 2012; Daly et al, 2010; Gabriel et al, 2015; Hatler et al, 2012; Morrison et al, 2011; Penrod et al, 2006; 2010; Yoo et al, 2012; 2013; Whitford et al, 2014), and 10 were selected with respect to in-hospital mortality (Ahrens et al, 2003; Ciemins et al 2007; Cox et al, 2012; Daly et al, 2010; Digwood et al, 2011; Lamba et al, 2012; Norton et al, 2007; Paris & Morrison, 2014; Yoo et al, 2012; 2013). Five studies were duplicates with regard to hospital length of stay and in-hospital mortality.…”