Xie Zhigang, Chen Guanming, Oladeru Oluwadamilola T, Hamadi Hanadi Y, Montgomery Lucinda, Robinson Maisha T, Hong Young-Rock
Department of Public Health, University of North Florida, Jacksonville, FL, USA.
Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
Am J Hosp Palliat Care. 2025 Mar;42(3):261-272. doi: 10.1177/10499091241252685. Epub 2024 May 6.
. Despite the potential of palliative care (PC) to enhance the quality of life for patients with advanced dementia, there is limited knowledge of its inpatient utilization patterns. This study investigated inpatient PC consultation utilization patterns and evaluated its impact on hospital length of stay (LOS) and medical costs among older patients diagnosed with Alzheimer's Disease and Related Dementia who were at a high risk of mortality (ADRD-HRM). . Using the 2016-2019 National Inpatient Sample database, we conducted multivariable logistic regression analyses to identify individual and hospital characteristics influencing PC consultation utilization. We subsequently performed generalized linear models to estimate LOS (using Poisson distribution) and hospital charges (via log-transformation). . Our sample encompassed 965,644 hospital discharges (weighted n = 4,828,219) of patients aged 65 years and above with ADRD-HRM. Among them, 14.6% received inpatient PC. There was a notable uptrend in PC consultation utilization from 13.3% in 2016 to 16.3% in 2019 ( trend<.001). Factors positively influencing and associated with PC utilization included patients that are older, non-Hispanic White, with higher income, receiving care from teaching hospitals, and facilitated with greater bed capacity (all < .05). Although patients who received PC were more likely to have 3.0% longer LOS ( < .001), they had 19.2% lower hospital charges ( < .001). . PC substantially reduced hospital expenditures for older patients with ADRD-HRM, but the prevalence remained low at 14.6% in the study period. Future studies should explore the unmet needs of patients with lower sociodemographic status and those in rural hospitals to further increase their PC consultation utilization.
尽管姑息治疗（PC）有潜力提高晚期痴呆患者的生活质量，但其住院使用模式的相关知识却很有限。本研究调查了住院PC咨询的使用模式，并评估了其对被诊断患有阿尔茨海默病及相关痴呆且死亡风险高的老年患者（ADRD-HRM）的住院时间（LOS）和医疗费用的影响。使用2016 - 2019年全国住院患者样本数据库，我们进行了多变量逻辑回归分析，以确定影响PC咨询使用的个体和医院特征。随后，我们进行了广义线性模型，以估计住院时间（使用泊松分布）和医院费用（通过对数转换）。我们的样本包括965,644例65岁及以上患有ADRD-HRM的患者的医院出院病例（加权n = 4,828,219）。其中，14.6%接受了住院PC。PC咨询的使用率从2016年的13.3%显著上升至2019年的16.3%（趋势<0.001）。对PC使用有积极影响且与之相关的因素包括年龄较大、非西班牙裔白人、收入较高、在教学医院接受治疗以及病床容量较大的患者（均<0.05）。尽管接受PC的患者住院时间更有可能长3.0%（<0.001），但他们的医院费用降低了19.2%（<0.001）。PC大幅降低了ADRD-HRM老年患者的医院支出，但在研究期间患病率仍较低，为14.6%。未来的研究应探索社会人口统计学地位较低的患者以及农村医院患者未满足的需求，以进一步提高他们的PC咨询使用率。
