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Original Research |

Utilization of palliative care in patients with end-stage chronic obstructive pulmonary disease on home oxygen: national trends and barriers to care in the United States

Barret Rush, MD; Paul Hertz, MD; Alexandra Bond, MD; Robert McDermid, MD; Leo Anthony Celi, MD MPH MS
Author and Funding Information

Conflict of Interest: No authors disclose any conflicts of interest

1Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada

2Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA

3Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada

4Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

5Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada

6Beth Israel Deaconess Medical Center, Boston, MA, USA

Send Correspondence to: Dr. Barret Rush MD Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, CANADA.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.06.023
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Abstract

Objective  To investigate the use of palliative care (PC) in patients with end-stage chronic obstructive pulmonary disease (COPD) on home oxygen hospitalized for an exacerbation

Methods  Retrospective nationwide cohort analysis utilising the Nationwide Inpatient Sample (NIS). All patients >18 years of age with a diagnosis of COPD on home oxygen admitted for an exacerbation were included.

Results  55,208,382 hospitalizations from the 2006-2012 NIS samples were examined. There were 181,689 patients with COPD on home oxygen admitted for an exacerbation, 3,145 (1.7%) patients also had a palliative care contact. There was a 4.5-fold relative increase in PC referral from 2006 (0.45%) to 2012 (2.56%, p<0.01). Patients receiving palliative care consultations compared to those who did not were: older (75.0 years SD 10.9 vs 70.6 years SD 9.7, p<0.01), had longer hospitalizations (4.9 days IQR 2.6-8.2 vs 3.5 days IQR 2.1-5.6) and more likely to die in hospital (32.1% vs 1.5%, p<0.01). Race was significantly associated with referral to palliative care, with White patients referred more often than minorities (p<0.01). Factors associated with PC referral were: age (OR 1.03, 95% CI 1.02-1.04, p<0.01), metastatic cancer (OR 2.40, 95% CI 2.02-2.87, p<0.01), non-metastatic cancer (OR 2.75, 95% CI 2.43-3.11, p<0.01), invasive mechanical ventilation (OR 4.89, 95% CI 4.31-5.55, p<0.01), non-invasive mechanical ventilation (OR 2.84, 95% CI 2.58-3.12, p<0.01), and DNR status (OR 7.95, 95% CI 7.29-8.67, p<0.01).

Conclusions  The use of PC increased dramatically during the study period, however PC contact occurs only in a minority of end-stage COPD patients admitted with an exacerbation.


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