@article{ref1,
title="The impact of inpatient palliative care on end of life care among older trauma patients who die after hospital discharge",
journal="Journal of trauma and acute care surgery",
year="2018",
author="Lilley, Elizabeth J. and Lee, Katherine C. and Scott, John W. and Krumrei, Nicole J. and Haider, Adil H. and Salim, Ali and Gupta, Rajan and Cooper, Zara",
volume="85",
number="5",
pages="992-998",
abstract="BACKGROUND: Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. <br><br>METHODS: This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission. A non-PC control group was developed by exact-matching for age, comorbidity, admission year, injury severity, length of stay, and post-discharge survival. We employed logistic regression to evaluate six EOL care outcomes: discharge to hospice, rehospitalization, skilled nursing facility (SNF) or long-term acute care hospital (LTACH) admission, death in an institutional setting, and intensive care unit (ICU) admission or receipt of life-sustaining treatments (LST) during a subsequent hospitalization. <br><br>RESULTS: Of 294,665 patients who died within 180 days after discharge, 2.1% received inpatient PC. Among 5,693 matched pairs, inpatient PC was associated with increased odds of discharge to hospice (odds ratio [95% confidence interval] = 3.80 [3.54-4.09]) and reduced odds of rehospitalization (0.17[0.15-0.20]), SNF/LTACH admission (0.43[0.39-0.47]), death in an institutional setting (0.34[0.30-0.39]), subsequent ICU admission (0.51[0.36-0.72]), or receiving LST (0.56[0.39-0.80]). <br><br>CONCLUSIONS: Inpatient palliative care is associated with lower intensity and less burdensome EOL care in the geriatric trauma population. Nonetheless, it remains underutilized among those who die within 6 months after discharge. LEVEL OF EVIDENCE: Level III STUDY TYPE: Prognostic.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0000000000002000",
url="http://dx.doi.org/10.1097/TA.0000000000002000"
}