Volume 69, Issue 5 p. 1199-1207
Clinical Investigations

Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia

Deven Lackraj MPH

Deven Lackraj MPH

Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA

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Dio Kavalieratos PhD

Dio Kavalieratos PhD

Division of Palliative Medicine, Department of Family and Preventative Medicine, Emory University, Atlanta, Georgia, USA

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Komal P. Murali PhD

Komal P. Murali PhD

School of Nursing, Columbia University, New York, New York, USA

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Yewei Lu MS

Yewei Lu MS

Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA

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May Hua MD, MS

Corresponding Author

May Hua MD, MS

Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA

Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA

Address correspondence to May Hua, MD, MS, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH5, Room 527-D, New York, NY 10032.

E-mail: [email protected]

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First published: 01 February 2021
Citations: 9

Abstract

Background

In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization.

Objective

To determine whether implementation of hospital-based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia.

Design

Retrospective cohort study.

Setting

Fifty-one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded.

Participants

Hospitalized patients with dementia.

Measurements

The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference-in-difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends.

Results

During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19–1.51), P < .001). No meaningful differences in secondary outcomes were observed.

Conclusion

Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.