The impact of inpatient palliative care on end-of-life care among older trauma patients who die after hospital discharge

Lilley, Elizabeth J.; Lee, Katherine C.; Scott, John W.; Krumrei, Nicole J.; Haider, Adil H.; Salim, Ali; Gupta, Rajan; Cooper, Zara

doi:10.1097/ta.0000000000002000

Cited by 39 publications

(44 citation statements)

References 47 publications

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“…In this study, 15% of patients with any frailty received billing for inpatient palliative care during their surgical hospitalization, which is higher than in other acutely ill older surgical patients . A limitation of administrative data is that coding for palliative care underrepresents the actual delivery of primary palliative care .…”

Section: Discussionmentioning

confidence: 91%

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Lee

Streid

Sturgeon

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Few studies examine the impact of frailty on long-term patient-oriented outcomes after emergency general surgery (EGS). We measured the prevalence of frailty among older EGS patients and examined the impact of frailty on 1-year outcomes. DESIGN: Retrospective cohort study using 2008 to 2014 Medicare claims. SETTING: Acute care hospitals. PARTICIPANTS: Patients 65 years or older who received one of the five EGS procedures with the highest mortality burden (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy). MEASUREMENTS: A validated claims-based frailty index (CFI) identified patients who were not frail (CFI < .15), prefrail (.15 ≤ CFI < .25), mildly frail (.25 ≤ CFI < .35), and moderately to severely frail (CFI ≥ .35). Multivariable Cox regression compared 1-year mortality. Multivariable Poisson regression compared rates of post-discharge hospital encounters (hospitalizations, intensive care unit stay, emergency department visit) and home time over 1 year after discharge. All regression models adjusted for age, sex, race, admission from facility, procedure, sepsis, inpatient palliative care delivery, trauma center designation, hospital bed size, and teaching status, and they were clustered by patient and hospital referral region. RESULTS: Among 468 459 older EGS adults, 37.4% were pre-frail, 12.4% were mildly frail, and 3.6% were moderately to severely frail. Patients with mild frailty experienced a higher risk of 1-year mortality compared with non-frail patients (hazard ratio = 1.97; confidence interval [CI] = 1.94-2.01). In the year after discharge, patients with mild and moderate to severe frailty had more hospital encounters compared with non-frail patients (7.8 and 11.5 vs 2.0 per person-year; incidence rate ratio [IRR] = 4.01; CI = 3.93-4.08 vs IRR = 5.89; CI = 5.70-6.09, respectively). Patients with mild and moderate to severe frailty also had fewer days at home in the year after discharge compared with non-frail patients (256 and 203 vs 302 mean days; IRR = .97; CI = .96-.97 vs IRR = .95; CI = .94-.95, respectively). CONCLUSION: Older EGS patients with frailty are at increased risk for poor 1-year outcomes and decreased home time. Targeted interventions for older EGS patients with frailty during the index EGS hospitalization are urgently needed to improve long-term outcomes.

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Section: Discussionmentioning

confidence: 91%

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Lee

Streid

Sturgeon

et al. 2020

J American Geriatrics Society

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“…Only individuals continuously enrolled in hospice services were included in the final cohort. A secondary outcome was receipt of life‐sustaining treatment on subsequent admission (Table S2) . Mortality, defined as patient death occurring greater than 30 days from the index operation, was obtained from the SAF Denominator file .…”

Section: Methodsmentioning

confidence: 99%

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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Background: Use of hospice services among patients with pancreatic cancer following pancreatic resection remains unknown. Methods: Patients with pancreatic cancer who underwent resection were identified in the Medicare Standard Analytic Files. Outcomes included overall hospice use, early hospice enrollment (≥4 weeks before death), late hospice enrollment (initiation within 3 days of death), and Medicare expenditures. Results: Among the 4369 deceased individuals, three-fourths of patients (n = 3252, 74.4%) used hospice at the time of death. Patients who did not use hospice were more likely to be male, have a complication on index admission and receive life sustaining treatments on subsequent admissions (P < .05). Only one-third (32.2%) of patients initiated hospice services early. Medicare expenditure during the last month of life was $10 000 lower among patients who initialized hospice services at least 1 month before death versus within 3 days of death (late: $10 581 [$5454-$17 200], early: $221 [$46-$733]; P < .001) Conclusion: While three-fourths of patients utilized hospice services after pancreatic resection, only one-third of patients initiated hospice services at least one-month before death. Late hospice use was associated with higher Medicare expenditures during the last month of life. Further research is needed to understand barriers to early hospice utilization.

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“…Second, and more likely, the frequent discussions on end-of-life goals and end-of-life planning with the GNP, and the in-depth knowledge the GNP had for hospice requirements allowed better placement of those patients who would benefit from hospice care. 23,24 10 3) 4 (1To our knowledge, we are the first to integrate geriatric specialists directly into the trauma team. Previous studies used consultations, stand-alone interprofessional teams and separate geriatric wards, and one study integrated a geriatric specialist into the emergency department, the closest model to the one in this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…First, patients might have recovered less and been more likely to require end‐of‐life care, which is unlikely given no change in death rates and the increased number of patients sent home/to rehabilitation. Second, and more likely, the frequent discussions on end‐of‐life goals and end‐of‐life planning with the GNP, and the in‐depth knowledge the GNP had for hospice requirements allowed better placement of those patients who would benefit from hospice care 23,24 …”

Section: Discussionmentioning

confidence: 99%

Impact of geriatric trauma service on the outcome of older trauma patents

Leede

Fry

Crosby

et al. 2020

Geriatrics Gerontology Int

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Aim The number of geriatric trauma patients is rising; yet, there is no established best team to care for them. This study analyzed a geriatric trauma service (GTS) that is integrated into the trauma surgery workflow rather than a separate consultation service. We hypothesize this team will lead to decreased mortality, shorter length of stay and increased favorable discharges for geriatric trauma patients. Methods In July 2017, we established a GTS consisting of geriatric nurse practitioners who were part of the hospital's geriatrics service, trauma surgeons and surgery residents on the acute care surgery service. The geriatric nurse practitioners were integrated into the trauma surgery workflow and functioned as independent members. The GTS responded to traumas and consultations for patients aged ≥65 years. Trauma surgeons carried out intensive care and operative management, while the geriatric nurse practitioners managed medical issues, family communication and end‐of‐life planning. We carried out a 2 year retrospective analysis of trauma patients aged ≥65 years seen at Dell Seton Medical Center at the University of Texas, Austin, Texas, USA, comparing patient outcomes before and after the GTS. The primary outcome was mortality, whereas secondary outcomes included hospital days, intensive care unit days, and discharge disposition. Results We found no difference in mortality, intensive care unit days or hospital days with the GTS. However, post‐GTS patients were more often discharged to home, rehabilitation, or hospice, and less often to nursing homes. Conclusion An integrated geriatric and trauma team is feasible, and significant changes in disposition can be made by utilizing geriatric nurse practitioners. Geriatr Gerontol Int 2020; 20: 817–821.

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The impact of inpatient palliative care on end-of-life care among older trauma patients who die after hospital discharge

Abstract: Therapeutic/Care management, level III.

Cited by 39 publications

References 47 publications

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Impact of geriatric trauma service on the outcome of older trauma patents

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