Im James Hb, Chow Ronald, Novosel Madison, Xiang Jenny, Strait Michael, Rao Vinay, Kapo Jennifer, Zimmermann Camilla, Prsic Elizabeth
Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Support Palliat Care. 2023 Feb 27. doi: 10.1136/spcare-2023-004207.
We aimed to explore the association between receiving an inpatient palliative care consultation and hospital outcomes, including in-hospital death, intensive care unit (ICU) use, discharge to hospice, 30-day readmissions and 30-day emergency department (ED) visits.
We conducted a retrospective chart review of Yale New Haven Hospital medical oncology admissions from January 2018 through December 2021, with and without inpatient palliative care consultations. Hospital outcome data were extracted from medical records and operationalised as binary. Multivariable logistic regression was used to estimate ORs for the association between number of inpatient palliative care consultations and hospital outcomes.
Our sample included 19 422 patients. Age, Rothman Index, site of malignancy, length of stay, discharge to hospice, ICU admissions, hospital death and readmissions within 30 days differed significantly between patients who received versus did not receive a palliative care consultation. On multivariable analysis, receiving one additional palliative care consultation was significantly associated with higher odds of hospital death (adjusted OR=1.15, 95% CI 1.12 to 1.17) and discharge to hospice (adjusted OR = 1.23, 95% CI 1.20 to 1.26), and lower odds of ICU admission (adjusted OR=0.94, 95% CI 0.92 to 0.97). There was no significant association between palliative care consultations and readmission within 30 days or with ED visits within 30 days.
Inpatients receiving palliative care had increased likelihood of hospital death. However, when controlling for significant differences in patient presentation, patients had nearly 25% greater odds of discharge to hospice and less odds to transition to ICU level of care.
我们旨在探讨接受住院姑息治疗会诊与医院结局之间的关联，包括院内死亡、重症监护病房（ICU）使用情况、转至临终关怀机构、30天再入院率和30天急诊就诊情况。
我们对2018年1月至2021年12月期间耶鲁纽黑文医院医学肿瘤住院患者进行了回顾性病历审查，这些患者接受或未接受住院姑息治疗会诊。医院结局数据从病历中提取并转化为二元数据。采用多变量逻辑回归来估计住院姑息治疗会诊次数与医院结局之间关联的比值比（OR）。
我们的样本包括19422名患者。接受姑息治疗会诊与未接受姑息治疗会诊的患者在年龄、罗斯曼指数、恶性肿瘤部位、住院时间、转至临终关怀机构、ICU入院、院内死亡和30天内再入院方面存在显著差异。在多变量分析中，每多接受一次姑息治疗会诊，院内死亡几率显著增加（调整后OR = 1.15，95%置信区间1.12至1.17），转至临终关怀机构的几率也显著增加（调整后OR = 1.23，95%置信区间1.20至1.26），而ICU入院几率降低（调整后OR = 0.94，95%置信区间0.92至0.97）。姑息治疗会诊与30天内再入院或30天内急诊就诊之间无显著关联。
接受姑息治疗的住院患者院内死亡可能性增加。然而，在控制患者表现的显著差异后，患者转至临终关怀机构的几率增加近25%，转至ICU护理水平的几率降低。
