The impact of inpatient palliative care on end of life care among older trauma patients who die after hospital discharge

Background Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. Methods This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission. A non-PC control group was developed by exact-matching for age, comorbidity, admission year, injury severity, length of stay, and post-discharge survival. We employed logistic regression to evaluate six EOL care outcomes: discharge to hospice, rehospitalization, skilled nursing facility (SNF) or long-term acute care hospital (LTACH) admission, death in an institutional setting, and intensive care unit (ICU) admission or receipt of life-sustaining treatments (LST) during a subsequent hospitalization. Results Of 294,665 patients who died within 180 days after discharge, 2.1% received inpatient PC. Among 5,693 matched pairs, inpatient PC was associated with increased odds of discharge to hospice (odds ratio [95% confidence interval] = 3.80 [3.54-4.09]) and reduced odds of rehospitalization (0.17[0.15-0.20]), SNF/LTACH admission (0.43[0.39-0.47]), death in an institutional setting (0.34[0.30-0.39]), subsequent ICU admission (0.51[0.36-0.72]), or receiving LST (0.56[0.39-0.80]). Conclusions Inpatient palliative care is associated with lower intensity and less burdensome EOL care in the geriatric trauma population. Nonetheless, it remains underutilized among those who die within 6 months after discharge. Level of Evidence Level III Study Type Prognostic Corresponding Author: Elizabeth J Lilley, 1 Robert Wood Johnson Place, MEB 594, New Brunswick, NJ 08901. (201) 694-8670. lilleyej@rwjms.rutgers.edu Conflicts of Interests: EJL: No conflicts of interest KCL: No conflicts of interest JWS: No conflicts of interest NJK: No conflicts of interest AHH: No conflicts of interest AS: No conflicts of interest RG: No conflicts of interest ZC: No conflicts of interest List of Meetings: 48th Annual Meeting of the Western Trauma Association, February 25 – March 2, 2018 in Whistler, British Columbia, Canada. 41st Annual Residents Trauma Papers Competition during the American College of Surgeons Committee on Trauma Annual Meeting, March 8, 2018 in San Antonio, Texas, United States Disclosures of funding: ZC is supported by the Paul B. Beeson Emerging Leaders Career Development Award in Aging (1K76AG054859-01). © 2018 Lippincott Williams & Wilkins, Inc.

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