Differential Utilization of Palliative Care Consultation Between Medical and Surgical Services

American Journal of Hospice and Palliative Medicine - Tập 37 Số 4 - Trang 250-257 - 2020
Minh-Thuy Nguyen1, Timothy Feeney2,1, Chanmin Kim3, Frederick Thurston Drake2,1, Suzanne Mitchell2,1, Magdalena Bednarczyk4, Sabrina E. Sanchez2,1
1Boston University School of Medicine, Boston, MA, USA
2Boston Medical Center, Boston, MA USA
3Boston University School of Public Health, Boston, MA, USA
4Rush University Medical Center Chicago IL USA

Tóm tắt

There is a paucity of data regarding the utilization of palliative care consultation (PCC) in surgical specialties. We conducted a retrospective review of 2321 adult patients (age ≥18) who died within 6 months of admission to Boston Medical Center from 2012 to 2017. Patients were included for analysis if their length of stay was more than 48 hours and if, based on their diagnoses as determined by literature review and expert consensus, they would have benefited from PCC. Bayesian regression was used to estimate the odds ratio (OR) and 99% credible intervals (CrI) of receiving PCC adjusted for age, sex, race, insurance status, median income, and comorbidity status. Among the 739 patients who fit the inclusion criteria, only 30% (n = 222) received PCC even though 664 (90%) and 75 (10%) of these patients were identified as warranting PCC on medical and surgical services, respectively. Of the 222 patients who received PCC, 214 (96%) were cared for by medical services and 8 (4%) were cared for by surgical services. Patients cared for primarily by surgical were significantly less likely to receive PCC than primary patients of medical service providers (OR, 0.19, 99% CrI, 0.056-0.48). At our institution, many surgical patients appropriate for PCC are unable to benefit from this service due to low consultation numbers. Further investigation is warranted to examine if this phenomenon is observed at other institutions, elucidate the reasons for this disparity, and develop interventions to increase the appropriate use of PCC throughout all medical specialties.

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Tài liệu tham khảo

10.1097/CCM.0b013e31823bc8e7

10.1378/chest.13-1351

10.1377/hlthaff.2017.0157

10.1177/0269216313493466

10.1089/jpm.2015.0233

Higginson IJ, 2017, BMC Geriatr, 17

10.1161/JAHA.113.000544

10.1177/1049909111410306

Berlin A, 2017, Surgery (United States), 163, 444

10.1177/0269216317701383

10.1513/AnnalsATS.201510-666PS

10.2215/CJN.12231116

10.1164/rccm.201307-1229OC

10.1089/jpm.2015.0351

10.1177/1062860618768069

10.1089/jpm.2013.9468

10.1111/j.1532-5415.2000.tb03144.x

10.1016/j.jpainsymman.2017.11.031

10.1089/jpm.2006.0155

10.1177/0269216314534514

10.1089/jpm.2015.0236

10.1089/jpm.2015.0367

Team RC, 2017, R: A Language and Environment for Statistical Computing

10.1016/j.surge.2012.07.003

Reville B, 2010, J Palliative Care, 13, 1261

10.1097/MD.0000000000002981

10.1001/jamasurg.2014.2101

10.1245/s10434-006-9324-1

10.1186/cc9346

Hoepelman AIM, 2014, Int J Geriatr Psychiatry, 30, 487

10.1089/jpm.2010.0347

10.1093/annonc/mds092

10.1016/j.cardfail.2016.04.004

10.1016/j.chest.2016.06.023

Veigh CM, 2018, BMC Palliat Care, 17, 1

10.4103/IJPC.IJPC_14_17

Sera L, 2014, NIH Public Access, 22, 69

10.1111/jgs.14799

10.1177/1049909114530183

10.1093/geront/gnu178

10.1089/jpm.2006.9989

10.7748/ns.25.1.48.s56

10.1007/s40265-017-0804-3

10.1177/1049909115624703

10.1089/jpm.2016.0315

10.1016/j.ijnurstu.2017.07.007

10.21037/apm.2017.08.15

10.1177/0269216310380764

10.1177/0269216313477177

10.1177/0269216317701383

10.1016/bs.irn.2017.05.014

10.1191/0269216303pm595oa

Carlsson ME, 2017, J Palliat Care, 20, 53

10.1111/j.1742-481X.2010.00682.x

10.1016/j.otc.2008.09.005

10.1016/j.bpg.2018.11.010

10.21037/apm.2017.09.02

10.1097/NOR.0000000000000381

10.1089/jpm.2015.0237

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American Journal of Hospice and Palliative Medicine

Tập 37 Số 4

250-257

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