• J Pain Symptom Manage · Aug 2023

    Functional status changes in patients receiving palliative care consult during COVID-19 pandemic.

    • Luyi Xu, Li Zeng, Emily Chai, Rolfe Sean Morrison, and Laura P Gelfman.
    • Division of Pulmonary (L.X.), Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine (L.X., L.Z., E.C., R.S.M., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: luyi.xu@mountsinai.org.
    • J Pain Symptom Manage. 2023 Aug 1; 66 (2): 137145.e3137-145.e3.

    ContextHospitalized patients with functional impairment have higher symptom burden and mortality. Little is known about how increased patient volume and acuity during the coronavirus disease 2019 (COVID-19) pandemic affected access to palliative care among patients with functional impairment.ObjectivesTo examine changes in functional status and hospital outcomes among patients receiving inpatient palliative care consultation before, during and after the COVID-19 pandemic.MethodsWe conducted a retrospective, multisite cohort study of all adult patients (≥ 18 years) admitted to four hospitals in New York City, USA, who received inpatient palliative care consultation between March 1, 2019 and February 28, 2022 with documented functional status at the time of consultation measured by Karnofsky Performance Status scale.ResultsAmong 13,180 eligible patients identified, patients' functional status at the time of consultation decreased as palliative care consult volume increased with the onset of the pandemic. Compared to pre-pandemic, there was a statistically significant trend of lower functional status (P < 0.001) and higher in-hospital mortality (P < 0.001) among patients with noncancer and non-COVID-19 diagnoses two years after the pandemic. In contrast, patients with cancer had a statistically significant trend of higher functional status (P < 0.001) and no significant changes in in-hospital mortality over time.ConclusionAs the healthcare system was stressed with high demand and limited resources, palliative care consultation prioritized highest acuity patients by shifting towards those with lower functional status and higher in-hospital mortality. This shift disproportionately affected noncancer patients. Innovative approaches to ensure upstream palliative care consultation during increased resource constraints are needed.Published by Elsevier Inc.

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