Yamada Yuji, Kobayashi Takaaki, Eyck Patrick Ten, Ren Renee, Fujitani Shigeki, Ko Fred
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Emergency Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
J Palliat Care. 2025 Apr;40(2):120-128. doi: 10.1177/08258597241290982. Epub 2024 Oct 15.
To assess the trends in palliative care consultation utilization and identify associated factors among older adults hospitalized with hip fractures in the United States between 2016 and 2020. We conducted a retrospective cohort study using data from the National Inpatient Sample from 2016 to 2020. The study included patients aged 65 and older admitted to hospital with a primary diagnosis of hip fracture. We identified palliative care consultations using ICD-10 code Z51.5. Multivariate logistic regression analyses were performed to identify predictors of palliative care utilization, adjusting for demographics, clinical variables, and hospital characteristics. A total of 293,749 admissions for hip fractures were identified, of which 9546 (3.2%) had palliative care consultations. A consistent upward trend was seen in the proportion of patients receiving palliative care consultations across all fracture types. Patients of color (Black: odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.65-0.83; Hispanic: OR = 0.67, 95% CI: 0.60-0.75 compared to White), those in lower-income quartiles (lowest: OR = 0.81, 95% CI: 0.76-0.87 compared to highest), smaller hospital size (OR = 0.84, 95% CI: 0.79-0.89 compared to large), and rural hospital (OR = 0.63, 95% Cl: 0.59-0.68, compared to urban teaching) were associated with fewer palliative care consultations. The number of palliative care consultations during hip fracture hospital admission was low, although the proportion increased over time. Significant disparities were observed and further research should explore barriers to palliative care access and develop strategies to enhance its delivery across diverse healthcare settings.
评估2016年至2020年间美国髋部骨折住院老年人姑息治疗会诊利用情况的趋势，并确定相关因素。我们使用2016年至2020年全国住院患者样本数据进行了一项回顾性队列研究。该研究纳入了65岁及以上因髋部骨折为主诊断入院的患者。我们使用ICD - 10编码Z51.5识别姑息治疗会诊。进行多因素逻辑回归分析以确定姑息治疗利用的预测因素，并对人口统计学、临床变量和医院特征进行调整。共识别出293,749例髋部骨折入院病例，其中9546例（3.2%）接受了姑息治疗会诊。在所有骨折类型中，接受姑息治疗会诊的患者比例呈持续上升趋势。与白人相比，有色人种患者（黑人：比值比[OR]=0.73，95%置信区间[CI]：0.65 - 0.83；西班牙裔：OR = 0.67，95% CI：0.60 - 0.75）、低收入四分位数患者（最低：与最高相比，OR = 0.81，95% CI：0.76 - 0.87）、医院规模较小的患者（与大型医院相比，OR = 0.84，95% CI：0.79 - 0.89）以及农村医院患者（与城市教学医院相比，OR = 0.63，95% Cl：0.59 - 0.68）接受姑息治疗会诊的次数较少。髋部骨折住院期间姑息治疗会诊的次数较低，尽管比例随时间有所增加。观察到显著差异，进一步研究应探索姑息治疗获取的障碍，并制定策略以加强其在不同医疗环境中的提供。
