1. Association of Palliative Care Use and Setting With Health-care Utilization and Quality of Care at the End of Life Among Patients With Advanced Lung Cancer
- Author
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Jodi Lapidus, Donald R. Sullivan, Christopher G. Slatore, Kelly C. Vranas, and Linda Ganzini
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,Palliative care ,Critical Care and Intensive Care Medicine ,Rate ratio ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Lung cancer ,Veterans Affairs ,Aged ,Neoplasm Staging ,Quality of Health Care ,Retrospective Studies ,Terminal Care ,business.industry ,Palliative Care ,Retrospective cohort study ,Patient Acceptance of Health Care ,medicine.disease ,Home Care Services ,United States ,Hospitalization ,030228 respiratory system ,Emergency medicine ,Propensity score matching ,Quality of Life ,Female ,Comprehensive Health Care ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Palliative care is associated with improved survival and quality of life among patients with lung cancer; however, its influence on health-care utilization and quality of care is unclear. Research Question Is palliative care, and the setting in which it occurs, associated with health-care resource utilization and quality of care among patients with advanced lung cancer? Study Design and Methods This was a retrospective cohort study of 23,142 patients with stage IIIB/IV lung cancer in the Veterans Affairs HealthCare System between 2007 and 2013. Exposures included the receipt of specialist-delivered palliative care, and the setting of the initial palliative care encounter (inpatient or outpatient) received after cancer diagnosis. Primary outcomes included rates of ED visits, along with rates of hospitalization and odds of ICU admission within the last 30 days of life. Secondary outcomes included any health-care utilization (ED, hospital, or ICU) related to chemotherapy toxicity. We used propensity score methods to perform Poisson and logistic regression modeling. Results Among the 23,142 patients, 57% received palliative care, and 36% of initial palliative care encounters were outpatient. Compared with no palliative care, initial palliative care encounter in the outpatient setting was associated with reduced rates of ED visits (adjusted incidence rate ratio [aIRR], 0.86; 95% CI, 0.77-0.96) and hospitalizations in the last 30 days of life (aIRR, 0.64; 95% CI, 0.59-0.70). Initial palliative care encounters in both inpatient (adjusted OR [aOR], 0.63; 95% CI, 0.53-0.75) and outpatient (aOR, 0.42; 95% CI, 0.35-0.52) settings were associated with reduced odds of ICU admission in the last 30 days of life. Palliative care was also associated with reduced health-care utilization related to chemotherapy toxicity (aOR, 0.88; 95% CI, 0.82-0.95). Interpretation Palliative care (particularly in outpatient settings) is associated with reduced health-care utilization at the end of life and may improve the quality of care among patients with advanced lung cancer. These findings support the role of palliative care as an important component of comprehensive cancer care and highlight the potential benefits of outpatient palliative care services.
- Published
- 2020
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