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Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs.

Publication ,  Journal Article
Ashana, DC; Umscheid, CA; Stephens-Shields, AJ; Kohn, R; Madden, V; Harhay, MO; Chen, Y; Kerlin, MP
Published in: Crit Care Med
November 2019

OBJECTIVES: As ICUs are increasingly a site of end-of-life care, many have adopted end-of-life care resources. We sought to determine the association of such resources with outcomes of ICU patients. DESIGN: Retrospective cohort study. SETTING: Pennsylvania ICUs. PATIENTS: Medicare fee-for-service beneficiaries. INTERVENTIONS: Availability of any of one hospital-based resource (palliative care consultants) or four ICU-based resources (protocol for withdrawal of life-sustaining therapy, triggers for automated palliative care consultation, protocol for family meetings, and palliative care clinicians embedded in ICU rounds). MEASUREMENTS AND MAIN RESULTS: In mixed-effects regression analyses, admission to a hospital with end-of-life resources was not associated with mortality, length of stay, or treatment intensity (mechanical ventilation, hemodialysis, tracheostomy, gastrostomy, artificial nutrition, or cardiopulmonary resuscitation); however, it was associated with a higher likelihood of discharge to hospice (odds ratio, 1.58; 95% CI, 1.11-2.24), an effect that was driven by ICU-based resources (odds ratio, 1.37; 95% CI, 1.04-1.81) rather than hospital-based resources (odds ratio, 1.19; 95% CI, 0.83-1.71). Instrumental variable analysis using differential distance (defined as the additional travel distance beyond the hospital closest to a patient's home needed to reach a hospital with end-of-life resources) demonstrated that among those for whom differential distance would influence receipt of end-of-life resources, admission to a hospital with such resources was not associated with any outcome. CONCLUSIONS: ICU-based end-of-life care resources do not appear to change mortality but are associated with increased hospice utilization. Given that this finding was not confirmed by the instrumental variable analysis, future studies should attempt to verify this finding, and identify specific resources or processes of care that impact the care of ICU patients at the end of life.

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

November 2019

Volume

47

Issue

11

Start / End Page

1591 / 1598

Location

United States

Related Subject Headings

  • Young Adult
  • Withholding Treatment
  • Retrospective Studies
  • Referral and Consultation
  • Pennsylvania
  • Patient Discharge
  • Palliative Care
  • Middle Aged
  • Male
  • Intensive Care Units
 

Citation

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Ashana, D. C., Umscheid, C. A., Stephens-Shields, A. J., Kohn, R., Madden, V., Harhay, M. O., … Kerlin, M. P. (2019). Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs. Crit Care Med, 47(11), 1591–1598. https://doi.org/10.1097/CCM.0000000000003969
Ashana, Deepshikha Charan, Craig A. Umscheid, Alisa J. Stephens-Shields, Rachel Kohn, Vanessa Madden, Michael O. Harhay, Yong Chen, and Meeta Prasad Kerlin. “Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs.Crit Care Med 47, no. 11 (November 2019): 1591–98. https://doi.org/10.1097/CCM.0000000000003969.
Ashana DC, Umscheid CA, Stephens-Shields AJ, Kohn R, Madden V, Harhay MO, et al. Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs. Crit Care Med. 2019 Nov;47(11):1591–8.
Ashana, Deepshikha Charan, et al. “Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs.Crit Care Med, vol. 47, no. 11, Nov. 2019, pp. 1591–98. Pubmed, doi:10.1097/CCM.0000000000003969.
Ashana DC, Umscheid CA, Stephens-Shields AJ, Kohn R, Madden V, Harhay MO, Chen Y, Kerlin MP. Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs. Crit Care Med. 2019 Nov;47(11):1591–1598.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

November 2019

Volume

47

Issue

11

Start / End Page

1591 / 1598

Location

United States

Related Subject Headings

  • Young Adult
  • Withholding Treatment
  • Retrospective Studies
  • Referral and Consultation
  • Pennsylvania
  • Patient Discharge
  • Palliative Care
  • Middle Aged
  • Male
  • Intensive Care Units