Highlights
- ■Inpatient PCE is underutilized among COPD hospitalizations.
- ■The inpatient PCE is inversely associated with the risk of 30-day all-cause rehospitalization.
- ■This association varied by discharge destination and was statistically significant among those discharged to a facility (63%) and also among those discharged to home with home health (58%).
- ■The potential for a decreased burden of rehospitalization along with its current underutilization suggests that there may be opportunities to improve patient outcomes by the incorporation of inpatient PCE in the care of the hospitalized COPD patient.
Abstract
Background
Studies exist on the association between inpatient Palliative Care Encounter (iPCE)
and 30-day rehospitalization among cancer and several non-cancer conditions but limited
in persons with Chronic Obstructive Pulmonary Disease (COPD).
Objective
To assess the association between an iPCE with the risk of 30-day rehospitalization
after an index hospitalization for COPD.
Methods
We conducted a cross-sectional analysis of the Nationwide Readmissions Database (2010–2014).
Index hospitalizations were defined as persons ≥ 18 years of age, discharge destinations
of either Home/Routine, Home with Home Care, or a Facility, and an index hospitalization
with Diagnosis Related Group of COPD. The International Classification of Diseases,
9th revision codes were used to extract comorbidities and a Palliative Care Encounter
(V66.7).
Results
There were 3,163,889 index hospitalizations and iPCE occurred in 21,330 (0.67%). There
were 558,059 (17.63%) with a 30-day rehospitalization. An iPCE was associated with
a significantly lower adjusted odds of 30-day readmission (Odds Ratio [OR], 0.50;
95% Confidence Interval [CI], 0.46 to 0.54). By discharge destination, the odds of
30-day rehospitalization were for a discharged to a facility (OR, 0.37; 95% CI, 0.32
to 0.42), to home with home health (OR, 0.42; 95% CI, 0.37 to 0.47), and to home (OR,
0.98; 95% CI, 0.85 to 1.12) for those with relative to without iPCE.
Conclusion
Inpatient PCE was associated with a 50% lower relative odds of 30-day rehospitalization
after an index hospitalization for COPD. This association varied by discharge destination
being statistically significant among those with a discharge destination of a facility
(63%) and home with home care (58%).
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Article info
Publication history
Published online: November 18, 2022
Accepted:
November 7,
2022
Received in revised form:
October 26,
2022
Received:
June 17,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
