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J Pain Symptom Manage · Jun 2024
Factors associated with hospital admission in the last month: A retrospective single center analysis.
- Jessica E Ma, Maren K Olsen, Cara L McDermott, C Barrett Bowling, S Nicole Hastings, Tyler White, and David Casarett.
- Division of General Internal Medicine (J.E.M., D.C.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Geriatric Research Education and Clinical Center (J.E.M., C.L.M., C.B.B.), Durham VA Health System, Durham, North Carolina, USA; Center for the Study of Aging (C.B.B.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: Jessica.ma@duke.edu.
- J Pain Symptom Manage. 2024 Jun 1; 67 (6): 535543535-543.
ContextDriven by concerns about care quality, patient experience, and national metrics, health systems are increasingly focusing on identifying risk factors for patients who are hospitalized in the last month of life.ObjectiveTo evaluate patient factors associated with hospital admission in the last month (30 days).MethodsWe analyzed a retrospective cohort of 8488 patients with a primary care visit in a tertiary health system in the last year of life using a linked electronic health record and decedent dataset. We examined healthcare utilization (primary care, emergency, hospital, intensive care unit encounters) and end-of-life related outcomes (palliative care consultation, do-not-resuscitate orders, advance care planning documentation, hospice at hospital discharge, death in health system). Multivariable logistic regressions identified patient factors associated with admission in the last month.ResultsAbout 2202 (25.9%) patients had a hospital admission in the last month. Among the 1282 (15.1%) who died in a health system facility, most (1103/1282, 86.0%) were admitted to the hospital in the last month. Among patients with a hospital admission and discharged in the last month, 60.9% (686/1126) were discharged on hospice. Compared to those without these diseases, metastatic cancer, liver disease, or heart failure had the highest odds of admission in the last month (adjusted OR 2.36 95%CI 2.05-2.72; 2.28, 95%CI 1.98-2.62; and 2.17 95%CI 1.93-2.45 respectively).ConclusionsAs patients with heart or liver disease or metastatic cancer had the highest odds of admission in the last month, collaborative interventions between primary, palliative, and specialty care may improve quality of care at the end of life.Published by Elsevier Inc.
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