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Haire E, Worley E, Jones SG, Ling A, Stoneham B, Wiggins N. Could it have been predicted? A retrospective analysis of the last year of life for people who died whilst in an intermediate care centre. Future Healthc J 2024; 11:100136. [PMID: 38831941 PMCID: PMC11144746 DOI: 10.1016/j.fhj.2024.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Objectives Intermediate care centres (ICCs) exist in the UK to bridge between acute hospital and home for those with rehabilitation needs. A national study shows 25% of ICC in-patients died within a year of admission. High quality end-of-life care includes early conversations with a person and their loved ones about what matters to them; timely identification of those who are likely to be nearing the end of their life is key. Methods This retrospective quantitative review of 98 patient notes reviewed deaths in one NHS trust, comparing 50 deaths in the acute hospital and 48 in the ICC. Data included frailty score, previous hospital admissions, specialist palliative input and conversations between professionals, patients and their loved ones. Supportive and Palliative Care Indicators Tool (SPICT) scores were used to identify those likely to have a poor prognosis. Results Results showed statistically significant differences between the groups. The ICC cohort were older with higher clinical frailty scores. They were less likely to have previous hospital admissions but more likely to have poor prognostic features on final admission. Despite this, the possibility of deterioration was discussed them less frequently than the acute hospital cohort, and fewer saw the Palliative care team. Conclusion This data suggests support is needed in ICCs to recognise those likely to be nearing end-of-life. One challenge is patients are more likely to be seen as 'well' in a rehabilitation focused environment. This paper suggests a 'proactive approach' trial using SPICT for ongoing assessment of ICC in-patients supporting identification of a deteriorating person and avoid missed opportunities for key conversations.
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Affiliation(s)
- Ellen Haire
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Emma Worley
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Stuart Glynne Jones
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Andrea Ling
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Bethany Stoneham
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Natasha Wiggins
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
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2
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Tanuseputro P, Webber C, Downar J. Illness trajectories in the age of big data. BMJ 2024; 384:q510. [PMID: 38428967 DOI: 10.1136/bmj.q510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
| | - Colleen Webber
- Investigator, Bruyere Research Institute, Ottawa ON, Canada
- Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - James Downar
- Investigator, Bruyere Research Institute, Ottawa ON, Canada
- Ottawa Hospital Research Institute, Ottawa ON, Canada
- Department of Medicine, University of Ottawa, Ottawa ON, Canada
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3
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Murmann M, Manuel DG, Tanuseputro P, Bennett C, Pugliese M, Li W, Roberts R, Hsu AT. Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study. CMAJ 2024; 196:E209-E221. [PMID: 38408785 PMCID: PMC10896599 DOI: 10.1503/cmaj.221513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND In Canada, only 15% of patients requiring palliative care receive such services in the year before death. We describe health care utilization patterns among home care users in their last 6 months of life to inform care planning for older people with varying mortality risks and evolving care needs as they decline. METHODS Using population health administrative data from Ontario, we performed a retrospective cohort study involving home care clients aged 50 years and older who received at least 1 interRAI (Resident Assessment Instrument) Home Care assessment between April 2018 and September 2019. We report the proportion of clients who used acute care, long-term care, and palliative home care services within 6 months of their assessment, stratified by their predicted 6-month mortality risk using a prognostic tool called the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) and vital status. RESULTS The cohort included 247 377 adults, 11.9% of whom died within 6 months of an assessment. Among decedents, 50.6% of those with a RESPECT-estimated median survival of fewer than 3 months received at least 1 nonphysician palliative home care visit before death. This proportion declined to 38.7% and 29.5% among decedents with an estimated median survival between 3 and 6 months and between 6 and 12 months, respectively. INTERPRETATION Many older adults in Ontario do not receive any palliative home care before death. Prognostic tools such as RESPECT may improve recognition of reduced life expectancies and palliative care needs of individuals in their final years of life.
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Affiliation(s)
- Maya Murmann
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Douglas G Manuel
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Carol Bennett
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Michael Pugliese
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Wenshan Li
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Rhiannon Roberts
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Amy T Hsu
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
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4
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Prognostic Association Between Frailty and Post-Arrest Health Outcomes in Patients Receiving Home Care: A Population-Based Retrospective Cohort Study. Resuscitation 2023; 187:109766. [PMID: 36931455 DOI: 10.1016/j.resuscitation.2023.109766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
AIM To evaluate the association between frailty and post-cardiac arrest survival, functional decline, and cognitive decline, among patients receiving home care METHODS: Frailty was measured using the Clinical Frailty Scale (CFS) and a valid frailty index. We used multivariable logistic regression to measure the association between frailty and post-arrest outcomes after adjusting for age, sex, and arrest setting. Functional independence and cognitive performance were measured using the interRAI ADL Long-Form and Cognitive Performance Scale, respectively. We conducted sub-group analytics of in-hospital and out-of-hospital arrests RESULTS: Our cohort consisted of 7,901 home care clients; most patients arrested out-of-hospital (55.4%) and were 75 years or older (66.3%). Most of the cohort was classified as frail (94.2%), with a CFS score of 5 or greater. The 30-day survival rate was higher for in-hospital (26.6%) than out-of-hospital cardiac arrests (5.2%). Most patients who survived to discharge had declines in post-arrest functional independence (65.8%) and cognitive performance (46.5%). A one-point increase in the CFS decreased the odds of 30-day survival by 8% (aOR=0.92; 95%CI = 0.87-0.97). A 0.1 unit increase in the frailty index reduced 30-day survival odds by 9% (aOR = 0.91; 95%CI = 0.86-0.96). The frailty index was associated with declines in functional independence (OR = 1.16; 95%CI = 1.02-1.31) and cognitive performance (OR = 1.24; 95%CI = 1.09-1.42), while the CFS was not. CONCLUSION Frailty is associated with cardiac arrest survival and post-arrest cognitive and functional status in patients receiving home care. Post-cardiac arrest cognitive and functional status are best predicted using more comprehensive frailty indices.
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5
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Hallet J, Coburn N, Eskander A. ASO Author Reflections: Understanding and Integrating Postoperative Patient-Reported Symptom Burden for Older Adults Undergoing Cancer Surgery. Ann Surg Oncol 2023; 30:709-710. [PMID: 36066657 DOI: 10.1245/s10434-022-12500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Canada. .,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Canada. .,ICES, Toronto, Canada. .,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Antoine Eskander
- Department of Surgery, University of Toronto, Toronto, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Canada.,ICES, Toronto, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
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6
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Pickering JW, Scrase R, Troughton R, Jamieson HA. Evaluation of the added value of Brain Natriuretic Peptide to a validated mortality risk-prediction model in older people using a standardised international clinical assessment tool. PLoS One 2022; 17:e0277850. [PMID: 36399481 PMCID: PMC9674136 DOI: 10.1371/journal.pone.0277850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
The ability to accurately predict the one-year survival of older adults is challenging for clinicians as they endeavour to provide the most appropriate care. Standardised clinical needs assessments are routine in many countries and some enable application of mortality prediction models. The added value of blood biomarkers to these models is largely unknown. We undertook a proof of concept study to assess if adding biomarkers to needs assessments is of value. Assessment of the incremental value of a blood biomarker, Brain Naturetic Peptide (BNP), to a one year mortality risk prediction model, RiskOP, previously developed from data from the international interRAI-HomeCare (interRAI-HC) needs assessment. Participants were aged ≥65 years and had completed an interRAI-HC assessment between 1 January 2013 and 21 August 2021 in Canterbury, New Zealand. Inclusion criteria was a BNP test within 90 days of the date of interRAI-HC assessment. The primary outcome was one-year mortality. Incremental value was assessed by change in Area Under the Receiver Operating Characteristic Curve (AUC) and Brier Skill, and the calibration of the final model. Of 14,713 individuals with an interRAI-HC assessment 1,537 had a BNP within 90 days preceding the assessment and all data necessary for RiskOP. 553 (36.0%) died within 1-year. The mean age was 82.6 years. Adding BNP improved the overall AUC by 0.015 (95% CI:0.004 to 0.028) and improved predictability by 1.9% (0.26% to 3.4%). In those with no Congestive Heart Failure the improvements were 0.029 (0.004 to 0.057) and 4.0% (0.68% to 7.6%). Adding a biomarker to a risk model based on standardised needs assessment of older people improved prediction of 1-year mortality. BNP added value to a risk prediction model based on the interRAI-HC assessment in those patients without a diagnosis of congestive heart failure.
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Affiliation(s)
- John W. Pickering
- Better Ageing with Big Data Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch Heart Institute, Christchurch, New Zealand
| | - Richard Scrase
- Te Whatu Ora–Health New Zealand, University of Otago, Christchurch, New Zealand
| | - Richard Troughton
- Department of Medicine, University of Otago, Christchurch Heart Institute, Christchurch, New Zealand
| | - Hamish A. Jamieson
- Better Ageing with Big Data Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand
- * E-mail:
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7
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Williams N, Hermans K, Cohen J, Declercq A, Jakda A, Downar J, Guthrie DM, Hirdes JP. The interRAI CHESS scale is comparable to the palliative performance scale in predicting 90-day mortality in a palliative home care population. BMC Palliat Care 2022; 21:174. [PMID: 36203180 PMCID: PMC9540725 DOI: 10.1186/s12904-022-01059-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Prognostic accuracy is important throughout all stages of the illness trajectory as it has implications for the timing of important conversations and decisions around care. Physicians often tend to over-estimate prognosis and may under-recognize palliative care (PC) needs. It is therefore essential that all relevant stakeholders have as much information available to them as possible when estimating prognosis. Aims The current study examined whether the interRAI Changes in Health, End-Stage Disease, Signs and Symptoms (CHESS) Scale is a good predictor of mortality in a known PC population and to see how it compares to the Palliative Performance Scale (PPS) in predicting 90-day mortality. Methods This retrospective cohort study used data from 2011 to 2018 on 80,261 unique individuals receiving palliative home care and assessed with both the interRAI Palliative Care instrument and the PPS. Logistic regression models were used to evaluate the relationship between the main outcome, 90-day mortality and were then replicated for a secondary outcome examining the number of nursing visits. Comparison of survival time was examined using Kaplan-Meier survival curves. Results The CHESS Scale was an acceptable predictor of 90-day mortality (c-statistic = 0.68; p < 0.0001) and was associated with the number of nursing days (c = 0.61; p < 0.0001) and had comparable performance to the PPS (c = 0.69; p < 0.0001). The CHESS Scale performed slightly better than the PPS in predicting 90-day mortality when combined with other interRAI PC items (c = 0.72; p < 0.0001). Conclusion The interRAI CHESS Scale is an additional decision-support tool available to clinicians that can be used alongside the PPS when estimating prognosis. This additional information can assist with the development of care plans, discussions, and referrals to specialist PC teams.
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Affiliation(s)
- Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, Canada.
| | - Kirsten Hermans
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Minderbroedersstraat 8 box, 5310, 3000, Leuven, Belgium.,End-of-life Care Research Group, University of Brussels (VUB) and Ghent University (UGent), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, University of Brussels (VUB) and Ghent University (UGent), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Anja Declercq
- LUCAS - Center for Care Research and Consultancy, KU Leuven, Minderbroedersstraat 8 box, 5310, 3000, Leuven, Belgium
| | - Ahmed Jakda
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, Canada
| | - James Downar
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, Canada.,Department of Health Sciences, Wilfrid Laurier University, 75 University Ave W, Waterloo, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, Canada
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8
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Alkeridy WA, Aljasser A, Alayed KM, Alsaad SM, Alqahtani AS, Lim CA, Alamri SH, Mekkawy DZ, Al-Sofiani M. Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia. J Multidiscip Healthc 2022; 15:1997-2005. [PMID: 36101552 PMCID: PMC9464450 DOI: 10.2147/jmdh.s379782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design Retrospective cross-sectional descriptive study. Setting and Participants A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods Only individuals fulfilling the HHC program’s eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.
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Affiliation(s)
- Walid A Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada.,General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia
| | - Arwa Aljasser
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Saad M Alsaad
- Department of Family & Community medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani S Alqahtani
- Research department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Claire Ann Lim
- Department of Medical Rehabilitation, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sultan H Alamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Saudi Geriatrics Society, Riyadh, Saudi Arabia
| | - Doaa Zainhom Mekkawy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Sofiani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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9
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Su CH, Lin SY, Lee CL, Lin CS, Hsu PS, Lee YS. Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137768. [PMID: 35805424 PMCID: PMC9265607 DOI: 10.3390/ijerph19137768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Several dimensional impairments regarding Comprehensive Geriatric Assessment (CGA) have been shown to be associated with the prognosis of older patients. The purpose of this study is to investigate mortality prediction factors based upon clinical characteristics and test in CGA, and then subsequently develop a prediction model to classify both short- and long-term mortality risk in hospitalized older patients after discharge. A total of 1565 older patients with a median age of 81 years (74.0−86.0) were consecutively enrolled. The CGA, which included assessment of clinical, cognitive, functional, nutritional, and social parameters during hospitalization, as well as clinical information on each patient was recorded. Within the one-year follow up period, 110 patients (7.0%) had died. Using simple Cox regression analysis, it was shown that a patient’s Length of Stay (LOS), previous hospitalization history, admission Barthel Index (BI) score, Instrumental Activity of Daily Living (IADL) score, Mini Nutritional Assessment (MNA) score, and Charlson’s Comorbidity Index (CCI) score were all associated with one-year mortality after discharge. When these parameters were dichotomized, we discovered that those who were aged ≥90 years, had a LOS ≥ 12 days, an MNA score < 17, a CCI ≥ 2, and a previous admission history were all independently associated with one-year mortality using multiple cox regression analyses. By applying individual scores to these risk factors, the area under the receiver operating characteristics curve (AUC) was 0.691 with a cut-off value score ≧ 3 for one year mortality, 0.801 for within 30-day mortality, and 0.748 for within 90-day mortality. It is suggested that older hospitalized patients with varying risks of mortality may be stratified by a prediction model, with tailored planning being subsequently implemented.
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Affiliation(s)
- Chih-Hsuan Su
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Shih-Yi Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan
| | - Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402010, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Chu-Sheng Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402010, Taiwan
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University, Taichung 402010, Taiwan
| | - Yu-Shan Lee
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Division of Neurology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Correspondence:
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10
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Webber C, Isenberg SR, Scott M, Hafid A, Hsu AT, Conen K, Jones A, Clarke A, Downar J, Kadu M, Tanuseputro P, Howard M. Inpatient Palliative Care Is Associated with the Receipt of Palliative Care in the Community after Hospital Discharge: A Retrospective Cohort Study. J Palliat Med 2022; 25:897-906. [PMID: 35007439 DOI: 10.1089/jpm.2021.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: For hospitalized patients with palliative care needs, there is little evidence on whether postdischarge outcomes differ if inpatient palliative care was delivered by a palliative care specialist or nonspecialist/generalist. Objective: To evaluate relationships between inpatient palliative care involvement and physician-delivered palliative care in the community after hospital discharge among individuals with limited life expectancy. Design: Population-based retrospective cohort study using administrative health data. Settings/Subjects: Adults with a predicted median survival of six months or less admitted to acute care hospitals in Ontario, Canada, between April 1, 2013, and March 31, 2017, and discharged to the community. Measurements: Inpatient palliative care involvement was classified as high (e.g., palliative care unit), medium (e.g., palliative care specialist consult), low (e.g., generalist-delivered palliative care), or none. Community palliative care included outpatient and home and clinic visits three weeks postdischarge. Results: Among 3660 hospitalized adults, 82 (2.2%) received inpatient palliative care with high level of involvement, 462 (12.6%) with medium level of involvement, 525 (14.3%) with low level of involvement, and 2591 (70.8%) had no inpatient palliative care. Patients who received inpatient palliative care were more likely to receive community palliative care after discharge than those who received no inpatient palliative care. These associations were stronger among patients who received high/medium palliative care involvement than patients who received low palliative care involvement. Conclusions: Inpatient palliative care, including that delivered by generalists, is associated with an increased likelihood of community palliative care after discharge. Increased inpatient generalist palliative care may help support patients' palliative care needs.
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Affiliation(s)
- Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Scott
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Abe Hafid
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Katrin Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Jones
- ICES, Ottawa, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anna Clarke
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada
| | - James Downar
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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11
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Heckman GA, Hubbard RE, Millar N. Mortality risk of patients in home care is modifiable. CMAJ 2021; 193:E1358. [PMID: 34462297 PMCID: PMC8432318 DOI: 10.1503/cmaj.79701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- George A Heckman
- Geriatrician and clinician scientist, Schlegel University of Waterloo Research Institute for Aging, Waterloo, Ont
| | - Ruth E Hubbard
- Geriatrician and clinician scientist, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Nigel Millar
- Geriatrician and Chief Medical Officer, Southern District Health Board NZ, Dunedin, New Zealand
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