Disparities in Palliative Care Utilization Among Hospitalized People With Huntington Disease: A National Cross-Sectional Study.
Leonard L Sokol, Danny Bega, Chen Yeh and 2 others
PMID 34291654WHAT IT FOUND
Only 3.8% of hospitalizations for Huntington disease in national data involved palliative care.
Lower household income, Medicare payer, and depression were associated with less palliative care, while DNR orders and extreme mortality risk were associated with more.
Key findings
01Only 321 of 8521 hospitalizations among people with Huntington disease (3.8%) included a palliative care consultation.
02After adjustment, palliative care consultation was associated with higher odds for private insurance versus Medicare, top-quartile income versus bottom income, extreme versus minor mortality risk, DNR order, aspiration pneumonia, or respiratory failure, and lower odds with depression.
03After adjustment, palliative care consultation was associated with lower odds of discharge to a facility, higher odds of discharge to home with services, and higher odds of in-hospital death.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used administrative hospital records, so it did not capture Huntington disease stage, functional level, patient values and preferences, caregiver distress, reason for admission, hospice use, or death after discharge. Repeated hospitalizations and the person who initiated the palliative care consultation were not accounted for. The design is cross-sectional and cannot show that palliative care consultation caused a different discharge location or death. Only 321 of 8521 hospitalizations had a palliative care consultation. Missing values were excluded rather than imputed.
The easy way to misread this
Do not read palliative care consultation as causing fewer facility discharges or more in-hospital deaths. The study is cross-sectional and administrative, so it cannot show whether consultation changed discharge, who initiated it, or whether patients had already chosen goals of care.