Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia
Background In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particul...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2021-05, Vol.69 (5), p.1199-1207 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
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| creator | Lackraj, Deven Kavalieratos, Dio Murali, Komal P. Lu, Yewei Hua, May |
| description | Background
In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization.
Objective
To determine whether implementation of hospital‐based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia.
Design
Retrospective cohort study.
Setting
Fifty‐one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded.
Participants
Hospitalized patients with dementia.
Measurements
The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference‐in‐difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends.
Results
During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19–1.51), P |
| doi_str_mv | 10.1111/jgs.17032 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8202070</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2527376801</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4432-a4e3ae0e0f49b80b51136592b4ad304cd5731cda2483ab7cc591b2cfdabfd29c3</originalsourceid><addsrcrecordid>eNp1kUtP3DAURi1UBNOBRf9AZambdjHgZ5LZVKqGloeQqASsrRvnBjxy4tROQPDr6zKAWqR648U9OvfxEfKBswOe3-H6Jh3wkkmxRWZcS7HQiut3ZMYYE4uq4GqXvE9pzRgXrKp2yK6UWkhVFDMCp93gscN-hNGFnoaWXg5oHXiXRvoTvHe5cId0BREp9A29mEYbOky0DZGehDS4McOP2GR6dFmU6L0bb-nRk9XBHtluwSfcf_7n5PrH96vVyeL84vh09e18YZXKI4NCCciQtWpZV6zWnMtCL0WtoJFM2UaXktsGhKok1KW1eslrYdsG6rYRSyvn5OvGO0x1h43NzSN4M0TXQXwwAZz5t9K7W3MT7kwlmGD5enPy-VkQw68J02g6lyx6Dz2GKZncOZ-VS11l9NMbdB2m2Of1jNCilGVRMZ6pLxvKxpBSxPZ1GM7Mn-BMDs48BZfZj39P_0q-JJWBww1w7zw-_N9kzo4vN8rfoWWkEg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2527376801</pqid></control><display><type>article</type><title>Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Lackraj, Deven ; Kavalieratos, Dio ; Murali, Komal P. ; Lu, Yewei ; Hua, May</creator><creatorcontrib>Lackraj, Deven ; Kavalieratos, Dio ; Murali, Komal P. ; Lu, Yewei ; Hua, May</creatorcontrib><description>Background
In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization.
Objective
To determine whether implementation of hospital‐based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia.
Design
Retrospective cohort study.
Setting
Fifty‐one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded.
Participants
Hospitalized patients with dementia.
Measurements
The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference‐in‐difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends.
Results
During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19–1.51), P < .001). No meaningful differences in secondary outcomes were observed.
Conclusion
Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.17032</identifier><identifier>PMID: 33523466</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Acute Disease ; Aged ; Aged, 80 and over ; Critical Care Outcomes ; Dementia ; Dementia - therapy ; Dementia disorders ; Dialysis ; Female ; Health Plan Implementation ; hospice ; Hospice Care - statistics & numerical data ; Hospitalization ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Length of Stay - statistics & numerical data ; Male ; Mechanical ventilation ; Multilevel Analysis ; New York ; Palliation ; Palliative care ; Palliative Care - methods ; Palliative Care - statistics & numerical data ; Patient Discharge - statistics & numerical data ; Patients ; Program Evaluation ; Quality of life ; Regression Analysis ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2021-05, Vol.69 (5), p.1199-1207</ispartof><rights>2021 The American Geriatrics Society</rights><rights>2021 The American Geriatrics Society.</rights><rights>2021 American Geriatrics Society and Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4432-a4e3ae0e0f49b80b51136592b4ad304cd5731cda2483ab7cc591b2cfdabfd29c3</citedby><cites>FETCH-LOGICAL-c4432-a4e3ae0e0f49b80b51136592b4ad304cd5731cda2483ab7cc591b2cfdabfd29c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.17032$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.17032$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33523466$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lackraj, Deven</creatorcontrib><creatorcontrib>Kavalieratos, Dio</creatorcontrib><creatorcontrib>Murali, Komal P.</creatorcontrib><creatorcontrib>Lu, Yewei</creatorcontrib><creatorcontrib>Hua, May</creatorcontrib><title>Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Background
In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization.
Objective
To determine whether implementation of hospital‐based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia.
Design
Retrospective cohort study.
Setting
Fifty‐one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded.
Participants
Hospitalized patients with dementia.
Measurements
The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference‐in‐difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends.
Results
During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19–1.51), P < .001). No meaningful differences in secondary outcomes were observed.
Conclusion
Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Critical Care Outcomes</subject><subject>Dementia</subject><subject>Dementia - therapy</subject><subject>Dementia disorders</subject><subject>Dialysis</subject><subject>Female</subject><subject>Health Plan Implementation</subject><subject>hospice</subject><subject>Hospice Care - statistics & numerical data</subject><subject>Hospitalization</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Multilevel Analysis</subject><subject>New York</subject><subject>Palliation</subject><subject>Palliative care</subject><subject>Palliative Care - methods</subject><subject>Palliative Care - statistics & numerical data</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Patients</subject><subject>Program Evaluation</subject><subject>Quality of life</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUtP3DAURi1UBNOBRf9AZambdjHgZ5LZVKqGloeQqASsrRvnBjxy4tROQPDr6zKAWqR648U9OvfxEfKBswOe3-H6Jh3wkkmxRWZcS7HQiut3ZMYYE4uq4GqXvE9pzRgXrKp2yK6UWkhVFDMCp93gscN-hNGFnoaWXg5oHXiXRvoTvHe5cId0BREp9A29mEYbOky0DZGehDS4McOP2GR6dFmU6L0bb-nRk9XBHtluwSfcf_7n5PrH96vVyeL84vh09e18YZXKI4NCCciQtWpZV6zWnMtCL0WtoJFM2UaXktsGhKok1KW1eslrYdsG6rYRSyvn5OvGO0x1h43NzSN4M0TXQXwwAZz5t9K7W3MT7kwlmGD5enPy-VkQw68J02g6lyx6Dz2GKZncOZ-VS11l9NMbdB2m2Of1jNCilGVRMZ6pLxvKxpBSxPZ1GM7Mn-BMDs48BZfZj39P_0q-JJWBww1w7zw-_N9kzo4vN8rfoWWkEg</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>Lackraj, Deven</creator><creator>Kavalieratos, Dio</creator><creator>Murali, Komal P.</creator><creator>Lu, Yewei</creator><creator>Hua, May</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202105</creationdate><title>Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia</title><author>Lackraj, Deven ; Kavalieratos, Dio ; Murali, Komal P. ; Lu, Yewei ; Hua, May</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4432-a4e3ae0e0f49b80b51136592b4ad304cd5731cda2483ab7cc591b2cfdabfd29c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Critical Care Outcomes</topic><topic>Dementia</topic><topic>Dementia - therapy</topic><topic>Dementia disorders</topic><topic>Dialysis</topic><topic>Female</topic><topic>Health Plan Implementation</topic><topic>hospice</topic><topic>Hospice Care - statistics & numerical data</topic><topic>Hospitalization</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Mechanical ventilation</topic><topic>Multilevel Analysis</topic><topic>New York</topic><topic>Palliation</topic><topic>Palliative care</topic><topic>Palliative Care - methods</topic><topic>Palliative Care - statistics & numerical data</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Patients</topic><topic>Program Evaluation</topic><topic>Quality of life</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lackraj, Deven</creatorcontrib><creatorcontrib>Kavalieratos, Dio</creatorcontrib><creatorcontrib>Murali, Komal P.</creatorcontrib><creatorcontrib>Lu, Yewei</creatorcontrib><creatorcontrib>Hua, May</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lackraj, Deven</au><au>Kavalieratos, Dio</au><au>Murali, Komal P.</au><au>Lu, Yewei</au><au>Hua, May</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2021-05</date><risdate>2021</risdate><volume>69</volume><issue>5</issue><spage>1199</spage><epage>1207</epage><pages>1199-1207</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>Background
In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization.
Objective
To determine whether implementation of hospital‐based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia.
Design
Retrospective cohort study.
Setting
Fifty‐one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded.
Participants
Hospitalized patients with dementia.
Measurements
The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference‐in‐difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends.
Results
During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19–1.51), P < .001). No meaningful differences in secondary outcomes were observed.
Conclusion
Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>33523466</pmid><doi>10.1111/jgs.17032</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0002-8614 |
| ispartof | Journal of the American Geriatrics Society (JAGS), 2021-05, Vol.69 (5), p.1199-1207 |
| issn | 0002-8614 1532-5415 |
| language | eng |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Acute Disease Aged Aged, 80 and over Critical Care Outcomes Dementia Dementia - therapy Dementia disorders Dialysis Female Health Plan Implementation hospice Hospice Care - statistics & numerical data Hospitalization Hospitalization - statistics & numerical data Hospitals Humans Length of Stay - statistics & numerical data Male Mechanical ventilation Multilevel Analysis New York Palliation Palliative care Palliative Care - methods Palliative Care - statistics & numerical data Patient Discharge - statistics & numerical data Patients Program Evaluation Quality of life Regression Analysis Retrospective Studies Treatment Outcome |
| title | Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia |
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