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Predictors of Death in the Hospital for Patients with Chronic Serious Illness
- Source :
- Journal of Palliative Medicine. 21:307-314
- Publication Year :
- 2018
- Publisher :
- Mary Ann Liebert Inc, 2018.
-
Abstract
- Most people prefer to die at home, yet most do not. Understanding factors associated with terminal hospitalization may inform interventions to improve care.Among patients with chronic illness receiving care in a multihospital healthcare system, we identified the following: (1) predictors of death in any hospital; (2) predictors of death in a hospital outside the system; and (3) trends from 2010 to 2015.Retrospective cohort using death certificates and electronic health records. Settings/Subjects: Decedents with one of nine chronic illnesses.Among 20,486 decedents, those most likely to die in a hospital were younger (odds ratio [OR] 0.977, confidence interval [CI] 0.974-0.980), with more comorbidities (OR 1.188, CI 1.079-1.308), or more outpatient providers (OR 1.031, CI 1.015-1.047); those with cancer or dementia, or more outpatient visits were less likely to die in hospital. Among hospital deaths, patients more likely to die in an outside hospital had lower education (OR 0.952, CI 0.923-0.981), cancer (OR 1.388, CI 1.198-1.608), diabetes (OR 1.507, CI 1.262-1.799), fewer comorbidities (OR 0.745, CI 0.644-0.862), or fewer hospitalizations within the system during the prior year (OR 0.900, CI 0.864-0.938). Deaths in hospital did not change from 2010 to 2015, but the proportion of hospital deaths outside the system increased (p 0.022).Patients dying in the hospital who are more likely to die in an outside hospital, and therefore at greater risk for inaccessibility of advance care planning, were more likely to be less well-educated and have cancer or diabetes, fewer comorbidities, and fewer hospitalizations. These findings may help target interventions to improve end-of-life care.
- Subjects :
- Male
Washington
medicine.medical_specialty
Palliative care
Psychological intervention
Death Certificates
03 medical and health sciences
0302 clinical medicine
Electronic Health Records
Humans
Medicine
Dementia
Hospital Mortality
030212 general & internal medicine
General Nursing
Aged
Demography
Retrospective Studies
business.industry
Health services research
Retrospective cohort study
General Medicine
Odds ratio
Middle Aged
medicine.disease
Confidence interval
Anesthesiology and Pain Medicine
030220 oncology & carcinogenesis
Chronic Disease
Emergency medicine
Female
business
End-of-life care
Subjects
Details
- ISSN :
- 15577740 and 10966218
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Journal of Palliative Medicine
- Accession number :
- edsair.doi.dedup.....614c761c807aef791adb945ab7330f2c