Palliative Care Access for Hospitalized Patients with End Stage Liver Disease Across the United States

Abstract

Objective:

Patients with end-stage liver disease (ESLD) often have a high symptom burden. Historically, palliative care (PC) services have been underutilized in this population. We investigated the use of PC services in patients with ESLD hospitalized across the United States.

Methods:

We utilized the Nationwide Inpatient Sample (NIS) to conduct a retrospective nationwide cohort analysis. All patients >18 years of age admitted with ESLD, defined as those with at least two liver decompensation events, were included in the analysis. A multivariate logistic regression model predicting referral to PC was created.

Results:

55,208,382 hospitalizations from the 2006-2012 NIS samples were analyzed with 39,349 (0.07%) patients meeting study inclusion. PC consultation was performed in 1,789 (4.5%) ESLD patients. The rate of PC referral in ESLD increased from 0.97% in 2006 to 7.1% in 2012 (p<0.01). In multivariate analysis, factors associated with lower referral to PC were Hispanic race (OR 0.77; 95% CI 0.66-0.89; p<0.01) and insurance coverage (OR 0.74; 95% CI 0.65-0.84; p<0.01). Factors associated with increased referral to PC were: age (per 5-year increase, OR 1.05; 95% CI 1.03-1.08; p<0.01), DNR status (OR 16.24; 95% CI 14.20-18.56; p<0.01), treatment in a teaching hospital (OR 1.25; 95% CI 1.12-1.39; p<0.01), presence of HCC (OR 2.00; 95% CI 1.71-2.33; p<0.01), and presence of metastatic cancer (OR 2.39; 95% CI 1.80 -3.18; p<0.01). PC referral was most common in West coast hospitals (OR 1.81; 95% CI 1.53-2.14; p<0.01) as well as large sized hospitals (OR 1.49; 95% CI 1.22-1.82; p<0.01).

Conclusions:

From 2006-2012 the use of PC in ESLD patients increased substantially. Socioeconomic, geographical and ethnic barriers to accessing PC were observed. This article is protected by copyright. All rights reserved.

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