TY  - JOUR
PY  - 2018//
TI  - The impact of inpatient palliative care on end of life care among older trauma patients who die after hospital discharge
JO  - Journal of trauma and acute care surgery
A1  - Lilley, Elizabeth J.
A1  - Lee, Katherine C.
A1  - Scott, John W.
A1  - Krumrei, Nicole J.
A1  - Haider, Adil H.
A1  - Salim, Ali
A1  - Gupta, Rajan
A1  - Cooper, Zara
SP  - 992
EP  - 998
VL  - 85
IS  - 5
N2  - 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>
LA  - en
SN  - 2163-0755
UR  - http://dx.doi.org/10.1097/TA.0000000000002000
ID  - ref1
ER  -