TY - JOUR
T1 - Association between the Implementation of Hospital-Based Palliative Care and Use of Intensive Care during Terminal Hospitalizations
AU - Hua, May
AU - Lu, Yewei
AU - Ma, Xiaoyue
AU - Morrison, R. Sean
AU - Li, Guohua
AU - Wunsch, Hannah
N1 - Publisher Copyright:
© 2020 JAMA Network Open. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Importance: The use of intensive care at the end of life continues to be common. Although the provision of palliative care has been advocated as a way to mitigate the use of high-intensity care, it is unknown whether implementation of hospital-based palliative care services is associated with reduced use of intensive care at the end of life. Objective: To determine whether implementation of hospital-based palliative care services is associated with decreased intensive care unit (ICU) use during terminal hospitalizations. Design, Setting, and Participants: This cohort study included 51 hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded. Participants were adult patients who died during hospitalization. Data analysis was performed between January 2018 and July 2019. Exposure: Implementation of a palliative care program. Main Outcomes and Measures: The primary outcome was ICU use. A difference-in-differences analysis was performed using multilevel regression to assess the association between implementing a palliative care program and ICU use during terminal hospitalizations while adjusting for patient and hospital characteristics and time trends. Results: During the study period, 73370 patients (mean [SD] age, 76.5 [14.1] years; 38467 [52.4%] women) died during hospitalization, of whom 37628 (51.3%) received care in hospitals that implemented palliative care services and 35742 (48.7%) received care in a hospital without palliative care implementation. Patients who received care in hospitals after implementation of palliative care services were less likely to receive intensive care than patients admitted to the same hospitals before implementation (49.3% vs 52.8%; difference 3.5%; 95% CI, 2.5%-4.5%; P <.001). Compared with hospitals that never had a palliative care program, the implementation of palliative care was associated with a 10% reduction in ICU use during terminal hospitalizations (adjusted relative risk, 0.90; 95% CI, 0.85-0.95; P <.001). Conclusions and Relevance: The implementation of hospital-based palliative care services in New York State was associated with a modest reduction in ICU use during terminal hospitalizations.
AB - Importance: The use of intensive care at the end of life continues to be common. Although the provision of palliative care has been advocated as a way to mitigate the use of high-intensity care, it is unknown whether implementation of hospital-based palliative care services is associated with reduced use of intensive care at the end of life. Objective: To determine whether implementation of hospital-based palliative care services is associated with decreased intensive care unit (ICU) use during terminal hospitalizations. Design, Setting, and Participants: This cohort study included 51 hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded. Participants were adult patients who died during hospitalization. Data analysis was performed between January 2018 and July 2019. Exposure: Implementation of a palliative care program. Main Outcomes and Measures: The primary outcome was ICU use. A difference-in-differences analysis was performed using multilevel regression to assess the association between implementing a palliative care program and ICU use during terminal hospitalizations while adjusting for patient and hospital characteristics and time trends. Results: During the study period, 73370 patients (mean [SD] age, 76.5 [14.1] years; 38467 [52.4%] women) died during hospitalization, of whom 37628 (51.3%) received care in hospitals that implemented palliative care services and 35742 (48.7%) received care in a hospital without palliative care implementation. Patients who received care in hospitals after implementation of palliative care services were less likely to receive intensive care than patients admitted to the same hospitals before implementation (49.3% vs 52.8%; difference 3.5%; 95% CI, 2.5%-4.5%; P <.001). Compared with hospitals that never had a palliative care program, the implementation of palliative care was associated with a 10% reduction in ICU use during terminal hospitalizations (adjusted relative risk, 0.90; 95% CI, 0.85-0.95; P <.001). Conclusions and Relevance: The implementation of hospital-based palliative care services in New York State was associated with a modest reduction in ICU use during terminal hospitalizations.
UR - http://www.scopus.com/inward/record.url?scp=85077707547&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2019.18675
DO - 10.1001/jamanetworkopen.2019.18675
M3 - Article
C2 - 31913493
AN - SCOPUS:85077707547
SN - 2574-3805
VL - 3
JO - JAMA network open
JF - JAMA network open
IS - 1
M1 - e1918675
ER -