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Original Research: COPD |

Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen: National Trends and Barriers to Care in the United States

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

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDivision of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada

bHarvard T. H. Chan School of Public Health, Harvard University, Boston, MA

cDivision of General Internal Medicine, University Health Network, Toronto, ON, Canada

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

eDepartment of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada

fBeth Israel Deaconess Medical Center, Boston, MA

CORRESPONDENCE TO: Barret Rush, MD, Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Rm 2438, Jim Pattison Pavilion, 2nd Floor, 855 W 12th Ave, Vancouver, BC, V5Z 1M9, Canada


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(1):41-46. doi:10.1016/j.chest.2016.06.023
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Background  To investigate the use of palliative care (PC) in patients with end-stage COPD receiving home oxygen hospitalized for an exacerbation.

Methods  A retrospective nationwide cohort analysis was performed, using the Nationwide Inpatient Sample. All patients ≥ 18 years of age with a diagnosis of COPD, receiving home oxygen, and admitted for an exacerbation were included.

Results  A total of 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Sample were examined. There were 181,689 patients with COPD, receiving home oxygen, and admitted for an exacerbation; 3,145 patients (1.7%) also had a PC contact. There was a 4.5-fold relative increase in PC referral from 2006 (0.45%) to 2012 (2.56%) (P < .01). Patients receiving PC consultations compared with those who did not were older (75.0 years [SD 10.9] vs 70.6 years [SD 9.7]; P < .01), had longer hospitalizations (4.9 days [interquartile range, 2.6-8.2] vs 3.5 days [interquartile range, 2.1-5.6]), and more likely to die in hospital (32.1% vs 1.5%; P < .01). Race was significantly associated with referral to palliative care, with white patients referred more often than minorities (P < .01). Factors associated with PC referral included age (OR, 1.03; 95% CI, 1.02-1.04; P < .01), metastatic cancer (OR, 2.40; 95% CI, 2.02-2.87; P < .01), nonmetastatic cancer (OR, 2.75; 95% CI, 2.43-3.11; P < .01), invasive mechanical ventilation (OR, 4.89; 95% CI, 4.31-5.55; P < .01), noninvasive mechanical ventilation (OR, 2.84; 95% CI, 2.58-3.12; P < .01), and Do Not Resuscitate status (OR, 7.95; 95% CI, 7.29-8.67; P < .01).

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

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