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Sohal A, Chaudhry H, Sharma R, Dhillon N, Kohli I, Singla P, Arora K, Dukovic D, Verma M, Roytman M. Recent Trends in Palliative Care Utilization in Patients With Decompensated Liver Disease: 2016-2020 National Analysis. J Palliat Med 2024; 27:335-344. [PMID: 37851991 DOI: 10.1089/jpm.2023.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background: Patients with end-stage liver disease (ESLD) have a poor quality of life, which often worsens as disease severity increases. Palliative care (PC) has emerged as a management option in ESLD patients, especially for those who are not candidates for a liver transplant. Objective: To assess the associated factors and trends in PC utilization in recent years. Design: We used the 2016-2020 National Inpatient Sample (NIS) database of the United States to identify patients with decompensated cirrhosis who suffered in-hospital mortality. Information regarding patient demographics, hospital characteristics, etiology and decompensations, Elixhauser comorbidities, and interventions was collected. The multivariate regression model was used to identify factors associated with PC use. Results: Out of 98,160 patients, 52,645 patients (53.6%) received PC consultations. PC utilization increased from 49.11% in 2016 to 56.85% in 2019, with a slight decrease to 54.47% in 2020. Patients with PC use had decreased incidence of blood transfusions (28.85% vs. 36.53%, p < 0.001), endoscopy (18% vs. 20.26%, p 0.0001), liver transplantation (0.28% vs. 0.69%, p < 0.001), and mechanical ventilation (46.22% vs. 56.37%, p < 0.001). African American, Hispanic, and Asian/Pacific Islander patients had 29%, 27%, and 23% lower odds of receiving PC than White patients. Patients in the two lowest income quartiles had 12% and 22% lower odds of receiving PC compared with the highest quartile. Conclusions: PC utilization in patients with ESLD is associated with decreased invasive procedures, shorter lengths of stay, and lower hospitalization charges. Minorities, as well as patients in the lower income quartiles, were less likely to receive PC.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, Fresno, California, USA
| | - Ragini Sharma
- Department of Internal Medicine, Maullana Azad Medical College, New Delhi, India
| | - Nimrat Dhillon
- Department of Internal Medicine, Shri Guru Ram Das Medical College, Amritsar, India
| | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Piyush Singla
- Department of Internal Medicine, Dayanand Medical College, and Hospital, Punjab, India
| | - Kirti Arora
- Department of Internal Medicine, Dayanand Medical College, and Hospital, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Miramar, Florida, USA
| | - Manisha Verma
- Department of Gastroenterology and Hepatology, Einstein Healthcare Network, Philadelphia, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, Fresno, Fresno, California, USA
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Mojtahedi Z, Yoo J, Kim P, Kim Y, Shen JJ, Wang BL. Changes in characteristics of inpatient respiratory conditions from 2019 to 2021 (before and during the COVID-19 pandemic). Front Public Health 2023; 11:1268321. [PMID: 38026399 PMCID: PMC10665887 DOI: 10.3389/fpubh.2023.1268321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background The COVID-19 pandemic has resulted in an increase in the number of individuals with respiratory conditions that require hospitalization, posing new challenges for the healthcare system. Recent respiratory condition studies have been focused on the COVID-19 period, with no comparison of respiratory conditions before and during the pandemic. This study aimed to examine hospital-setting respiratory conditions regarding potential changes in length of stay (LOS), mortality, and total charge, as well as socioeconomic disparities before and during the pandemic. Methods The study employed a pooled cross-sectional design based on the State Inpatient Data Nevada for 2019 (prior to the COVID-19 pandemic) and 2020-2021 (during the pandemic) and investigated all respiratory conditions, identified by the International Classification of Disease, 10th Revision codes (n = 227,338). Descriptive analyses were carried out for the three years. Generalized linear regression models were used for multivariable analyses. Outcome measures were hospital LOS, mortality, and total charges. Results A total of 227,338 hospitalizations with a respiratory condition were included. Hospitalizations with a respiratory condition increased from 65,896 in 2019 to 80,423 in 2020 and 81,018 in 2021. The average LOS also increased from 7.9 days in 2019 to 8.8 days in 2020 but decreased to 8.1 days in 2021; hospital mortality among patients with respiratory conditions increased from 7.7% in 2019 to 10.2% but decreased to 9.6% in 2021; and the total charges per discharge were $159,119, $162,151, and $161,733 from 2019 to 2021, respectively (after adjustment for the inflation rate). Hispanic, Asian, and other race patients with respiratory conditions were 1-3 times more likely than white patients to have higher mortality and LOS. Medicaid patients and non-White patients were predictors of a higher respiratory-related hospital total charge. Conclusion Demographic and socioeconomic factors were significantly associated with respiratory-related hospital utilization in terms of LOS, mortality, and total charge.
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Affiliation(s)
- Zahra Mojtahedi
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Ji Yoo
- School of Medicine, University of Nevada, Las Vegas, NV, United States
| | - Pearl Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Yonsu Kim
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Jay J. Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States
| | - Bing-Long Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Newport KB, Webb JA. Innovations and Opportunities for the Integration of Palliative Care in Cancer Care. Curr Probl Cancer 2023; 47:101016. [PMID: 37806918 DOI: 10.1016/j.currproblcancer.2023.101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Kristina B Newport
- Section of Palliative Care, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jason A Webb
- Section of Palliative Care, Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon; Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
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Abstract
Palliative care (PC), which improves the quality of life for patients with serious illnesses, can be offered in multiple settings, such as the hospital, community, and home. The trend toward delivering PC at home has been recently accelerated during the COVID-19 pandemic. The pandemic has created challenges for patients with serious illnesses who have been proven to be susceptible to serious COVID-19 illnesses. This review of the literature presents research studies on home PC (HPC) during the pandemic. Databases (PubMed, Scopus, and Web of Science Core Collection) were searched. Twelve research/case studies were found to be relevant. These articles gathered information either through qualitative (surveys/interviews) methods or medical records. Most qualitative articles focused on perceived challenges and opportunities from HPC professionals' perspectives. Adopting telehealth was frequently discussed as a key tool to adjust to the pandemic. In general, HPC professionals and patients had a positive attitude toward telehealth, and this attitude was much more pronounced among professionals than patients. Among HPC professionals, some reports indicated that their burnout rates reduced, and job satisfaction increased during the pandemic. Regarding clinical and cost outcomes, there is a gap in the literature on HPC during the pandemic. In conclusion, despite challenges, it seems that the pandemic has gifted some long-term opportunities for promoting HPC in combination with telehealth. COVID-19 will not be the last pandemic, and we should be prepared for the next one by updating policies and building concrete infrastructure for HPC.
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Affiliation(s)
- Zahra Mojtahedi
- Department of Healthcare
Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jay J Shen
- Department of Healthcare
Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA,Jay J Shen, PhD, Department of Healthcare
Administration and Policy School of Public Health University of Nevada, Las
Vegas, NV 89119, USA.
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Is There a Role for Palliative Services and Supportive Care in Managing Advanced Penile Cancer? Semin Oncol Nurs 2022; 38:151288. [DOI: 10.1016/j.soncn.2022.151288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mojtahedi Z, Shan G, Ghodsi K, Callahan K, Yoo JW, Vanderlaan J, Reeves J, Shen JJ. Inpatient palliative care utilisation among patients with gallbladder cancer in the United States: A 10-year perspective. Eur J Cancer Care (Engl) 2021; 31:e13520. [PMID: 34633118 DOI: 10.1111/ecc.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 06/26/2021] [Accepted: 09/24/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Gallbladder cancer (GBC) is a rare, poor-prognosis cancer with unique demographics, comorbidities and a paucity of research. This study investigated inpatient palliative care and its associations with demographics, comorbidities (e.g., obesity), length of stay and hospital charges in GBC in US hospitals (2007-2016). METHODS Data were extracted from the National Inpatient Sample (NIS) database that contains deidentified clinical and nonclinical information for each hospitalisation. Inpatient palliative care utilisation was identified using the International Classification of Diseases (ICD-9 and ICD-10) codes (V66.7 and Z51.5). Generalised regression analysis was conducted with adjustment for variations in predictors. RESULTS Of the 4921 reported GBC hospitalizations, only 10.3% encountered palliative care. Palliative care was associated with reduced hospital charges by $12,405 per hospitalisation (P < 0.0001) with no change in length of stay. Palliative care utilisation increased over time (P = 0.004). It was associated with age >80 years, with more severe disease, and in-hospital death (P < 0.0001). Obesity had a negative association with palliative care utilisation (P = 0.0029). DISCUSSION Our novel study found that obese people were less likely to use palliative care services in GBC. Interventions are needed to increase palliative care consultation in GBC patients, particularly in obese patients.
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Affiliation(s)
- Zahra Mojtahedi
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Guogen Shan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Katayoon Ghodsi
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Karen Callahan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Ji W Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | | | - Jerry Reeves
- HealtHIE Nevada, Comagine Health, Las Vegas, Nevada, USA
| | - Jay J Shen
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
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