Use of Inpatient Palliative Care by Type of Malignancy

Jessica M. Ruck, Joseph K. Canner, Thomas J Smith, Fabian Johnston

Research output: Contribution to journalArticle

Abstract

Background: Although mounting evidence supports the use of palliative care (PC) to improve care experiences and quality of life for oncology patients, the frequency of and factors associated with PC use during oncology-related hospitalizations remain unknown. Materials and Methods: Using the National Inpatient Sample dataset, hospitalizations during 2012-2014 for a primary diagnosis of cancer with high risk of in-hospital mortality were identified. PC use was identified using the V66.7 ICD-9 code. Factors associated with the cost of hospitalization were identified using multivariable gamma regression. Results: During the study period, 124,186 hospitalizations were identified with a primary diagnosis of malignancy (melanoma, breast, colon, gynecologic, prostate, male genitourinary, head/neck, urinary tract, noncolon gastrointestinal, lung, brain, bone/soft tissue, endocrine, or nonlung thoracic). Most patients were treated at a teaching hospital (51-77% by cancer type), and use of PC ranged from 10% for patients with endocrine cancers to 31% for patients with melanoma. Patients utilizing PC had a lower frequency of operative procedures (4-33% vs. 34-79% by cancer type, all p ≤ 0.001), a higher rate of in-hospital death (30-45% vs. 4-10% by cancer type, all p < 0.001), and a lower total hospitalization cost (median: $5076-17,151 vs. $10,918-29,287 by cancer type, p ≤ 0.01 except male genitourinary). In an adjusted analysis, the cost of hospitalization was significantly associated (all p < 0.001) with patient gender, race, age, operative, in-hospital death, extended length of stay, and PC. Conclusions: In summary, inpatient PC utilization varied by cancer type. PC was associated with lower utilization of surgical procedures, shorter length of stay, and lower hospitalization cost. Lower hospitalization cost was also seen for patients who were older, female, or African American.

Original languageEnglish (US)
Pages (from-to)1300-1307
Number of pages8
JournalJournal of Palliative Medicine
Volume21
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Palliative Care
Inpatients
Hospitalization
Neoplasms
Costs and Cost Analysis
International Classification of Diseases
Melanoma
Length of Stay
Endocrine Gland Neoplasms
Operative Surgical Procedures
Hospital Mortality
Urinary Tract
Teaching Hospitals
African Americans
Prostate
Colon
Breast
Neck
Thorax
Head

Keywords

  • hospitalization cost
  • inpatient
  • malignancy
  • National Inpatient Sample
  • oncology
  • palliative care

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

Use of Inpatient Palliative Care by Type of Malignancy. / Ruck, Jessica M.; Canner, Joseph K.; Smith, Thomas J; Johnston, Fabian.

In: Journal of Palliative Medicine, Vol. 21, No. 9, 01.09.2018, p. 1300-1307.

Research output: Contribution to journalArticle

Ruck, Jessica M. ; Canner, Joseph K. ; Smith, Thomas J ; Johnston, Fabian. / Use of Inpatient Palliative Care by Type of Malignancy. In: Journal of Palliative Medicine. 2018 ; Vol. 21, No. 9. pp. 1300-1307.
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abstract = "Background: Although mounting evidence supports the use of palliative care (PC) to improve care experiences and quality of life for oncology patients, the frequency of and factors associated with PC use during oncology-related hospitalizations remain unknown. Materials and Methods: Using the National Inpatient Sample dataset, hospitalizations during 2012-2014 for a primary diagnosis of cancer with high risk of in-hospital mortality were identified. PC use was identified using the V66.7 ICD-9 code. Factors associated with the cost of hospitalization were identified using multivariable gamma regression. Results: During the study period, 124,186 hospitalizations were identified with a primary diagnosis of malignancy (melanoma, breast, colon, gynecologic, prostate, male genitourinary, head/neck, urinary tract, noncolon gastrointestinal, lung, brain, bone/soft tissue, endocrine, or nonlung thoracic). Most patients were treated at a teaching hospital (51-77{\%} by cancer type), and use of PC ranged from 10{\%} for patients with endocrine cancers to 31{\%} for patients with melanoma. Patients utilizing PC had a lower frequency of operative procedures (4-33{\%} vs. 34-79{\%} by cancer type, all p ≤ 0.001), a higher rate of in-hospital death (30-45{\%} vs. 4-10{\%} by cancer type, all p < 0.001), and a lower total hospitalization cost (median: $5076-17,151 vs. $10,918-29,287 by cancer type, p ≤ 0.01 except male genitourinary). In an adjusted analysis, the cost of hospitalization was significantly associated (all p < 0.001) with patient gender, race, age, operative, in-hospital death, extended length of stay, and PC. Conclusions: In summary, inpatient PC utilization varied by cancer type. PC was associated with lower utilization of surgical procedures, shorter length of stay, and lower hospitalization cost. Lower hospitalization cost was also seen for patients who were older, female, or African American.",
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