Original articlePancreas, biliary tract, and liverPalliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life
Section snippets
Data Set
The National Inpatient Sample (NIS) is a large national database that contains annual clinical and resource utilization information from hospitalizations across the United States. It is a product of the Healthcare Cost and Utilization Project (HCUP) and the Agency for Healthcare Research and Quality.12 National data are obtained from a total of 44 states, and each state database contains random samples of hospitalizations from HCUP member hospitals, stratified by census division, hospital
Descriptive Statistics
From 2009 to 2013, the NIS contained 38,051,324 hospital discharges, representing 189,116,625 discharges. Among the 449,157 terminal hospitalizations over the 5-year period for adults with a length of stay of at least 3 days, 12,380 (2.8%) hospitalizations were for patients with end-stage liver disease. When weighted, our total sample size was 59,703 patients. Because these hospitalizations were terminal, each discharge represented a unique patient.
Among patients dying in the hospital with
Discussion
Among decedents with end-stage liver disease, we found that utilization of palliative care consultation during terminal hospitalizations was low but increased from 2009 to 2013. Total costs of hospitalization for end-stage liver disease patients did not increase significantly. Adjusting for patient and hospital factors, this national observational study showed that palliative care consultation is associated with lower costs of terminal hospitalization.
Recognizing that this is a decedent
Conclusions
Our study corroborates previous data suggesting that rates of palliative care consultation in patients with end-stage liver disease are low, while also showing that costs are exceedingly high for these terminally ill patients. Our findings of racial and ethnic disparities in palliative care access and variations in palliative care access and cost based on hospital factors and transplant status present unique opportunities for research and quality improvement for this population. The association
Acknowledgments
The authors acknowledge the contribution of Joni Ricks-Oddie, PhD of the UCLA Institute for Digital Research and Education Statistical Consulting Group (IDRE) for her invaluable assistance with the analysis for this manuscript.
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Conflicts of interest The authors disclose no conflicts.
Funding Supported by the Ruth L. Kirschstein Institutional National Research Service Award for Primary Care T32 (T32HP19001), the Specialty Training and Advanced Research (STAR) program at University of California Los Angeles (A.A.P); the National Institutes of Health/National Center for Advancing Translational Science University of California Los Angeles Clinical and Translational Science Institute (UL1TR000124), the National Institutes of Health loan repayment program, and the Cambia Health Foundation Sojourns Scholar Leadership Program (A.M.W.). The content is solely the responsibility of the authors and does not necessarily represent the official views of National Research Service Award or the National Institutes of Health.