Suboptimal Use of Inpatient Palliative Care Consultation May Lead to Higher Readmissions and Costs in End-Stage Liver Disease

Adejumo, Adeyinka Charles; Kim, Dong‐Hee; Iqbal, Umair; Yoo, Eric R.; Boursiquot, Brian C; Cholankeril, George; Wong, Robert J.; Kwo, Paul Y.; Ahmed, Aijaz

doi:10.1089/jpm.2019.0100

Cited by 16 publications

(17 citation statements)

References 38 publications

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“…On analyzing the national readmission database, we found that PC was associated with a significantly reduced odds of 30-d readmission in alcohol associated ESLD patients, with an adjusted odds ratio of 0.35 on multivariate analysis, accounting for several factors found to be associated with readmission rates such as age and ACLF score. We found that the rate of readmissions in our cohort of alcohol-associated ESLD patients with C use was lower than that of all ESLD patients which has been studied before[ 24 , 25 ]. Also, utilization of PC was lower than all-ESLD patients, where it was 5.3% vs 4.4% for our cohort of patients.…”

Section: Discussionmentioning

confidence: 69%

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

Gupta¹,

Hans²,

Khan³

et al. 2022

World J Hepatol

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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.

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Section: Discussionmentioning

confidence: 69%

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

Gupta¹,

Hans²,

Khan³

et al. 2022

World J Hepatol

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“…The present study suggests that interventions that optimize care coordination and safe discharge plans may be an effective solution. In fact, several recent studies, including one randomized controlled trial, have highlighted the effect of specialty palliative care consultation in reducing readmissions for patients with cirrhosis, consistent with this concept (18)(19)(20). In the outpatient and community settings, only one intervention, incorporating multidisciplinary care management and same day hospitals for procedures in hepatology clinics, effectively reduced both readmissions and mortality in a cohort of patients with cirrhosis (21).…”

mentioning

confidence: 78%

Reducing readmissions in patients with cirrhosis: the time to act is now

Patel¹,

Koola²,

Matheny³

2021

Ann Transl Med

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“…Similarly, palliative care consult has been reported to be used in only 4.5% to 5.3% of hospitalisations with end-stage liver disease in the US. 28,29 Symptom burden is high among patients with end-stage liver disease and in those with HRS, resulting in poor quality of life. 15 Use of palliative care in patients without cancer has been shown to reduce hospitalisations, symptom burden, and cost of medical care, with an improved quality of life score.…”

Section: Discussionmentioning

confidence: 99%

Healthcare burden and outcomes of hepatorenal syndrome among cirrhosis‐related hospitalisations in the US

Singal

Kuo

Reddy

et al. 2022

Aliment Pharmacol Ther

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Summary Background Hepatorenal syndrome (HRS) contributes to significant morbidity and mortality in hospitalised patients with cirrhosis. Aims To examine recent trends, magnitude and outcomes of HRS in the National Inpatient Sample (NIS) database Methods Among the NIS database on cirrhosis hospitalisations (2016–2019) due to alcohol (ALD), chronic viral hepatitis (CVH), or NASH and complicated by acute kidney injury (AKI) were analyzed. Results Of 113,454 hospitalisations, 18,735 (16.5%) had HRS (mean age 56 years, 36% females, 68% whites, 80% ALD, 7% NASH) with a stable trend over time. Among 1:1 propensity‐matched 36,090 hospitalisations, the odds of HRS were 12% higher in NASH versus CVH. Based on weighted national estimates, there were 27,180 (8.3 per 100,000 US population) HRS hospitalisations in 2019, with economic burden of $4.2 billion USD. Mean hospitalisation and total charges (ALD vs. CVH vs. NASH) were 11 versus 10.8 versus 9.2 days and 151,000 versus 157,000 versus 120,000 USD, respectively; p < 0.001. In‐hospital mortality was 18.9%, higher in HRS (25.8 vs. 12%, p < 0.001), and decreased by 15% annually. Survivors were more likely to be discharged to short‐ or long‐term care facilities (HRS vs. non‐HRS [42 vs. 27%, p < 0.001]); only 28.7% received palliative care. Conclusion HRS was the cause of AKI in 16.5% of patients hospitalised with cirrhosis and conferred significant healthcare burden with 27,180 HRS hospitalisations in 2019 and requiring an estimated 4.2 billion USD for hospital care. While there has been a decrease in in‐hospital mortality over time, it remained high at 23.7% in 2019 in those with HRS.

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Suboptimal Use of Inpatient Palliative Care Consultation May Lead to Higher Readmissions and Costs in End-Stage Liver Disease

Cited by 16 publications

References 38 publications

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

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

Reducing readmissions in patients with cirrhosis: the time to act is now

Healthcare burden and outcomes of hepatorenal syndrome among cirrhosis‐related hospitalisations in the US

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