University of Arkansas for Medical Sciences, Little Rock, AR
Mohammad Omar Atiq, Rahul Ravilla, Ajay Kumar, Sajjad Haider, Ji-Ling Tang, Konstantinos Arnaoutakis, Pooja Motwani, Eric R Siegel, Appalanaidu Sasapu, Fade A. Mahmoud, Sarah Elizabeth Harrington
Background: Numerous studies established that early utilization of palliative care-hospice services are beneficial to cancer patients. To reduce the incidence of aggressive care in terminal cancer patients, we conducted a quality improvement study to identify pertinent risk factors and develop interventions. Methods: Through chart review, we retrospectively identified patients with stage IV cancer that were followed by oncology clinic and were admitted to the University Hospital between 8/1/2015-10/31/15. For those patients who died during the last hospitalization or were discharged to hospice care, we obtained demographic, cancer related and practice related variables listed in Table. We used Mann Whitney U test and multivariable regression to find effects of factors related to length of stay (LOS) and cost of stay (COS). Results: Length of stay was significantly prolonged in those receiving chemotherapy within the past month (6 vs 3 p=0.035). Multivariate analyses found that patients with goals of care documented in the clinic had lower COS by 36.7% and LOS by 46.7%. On average, an ICU stay resulted in COS 2.2 times higher. No significant difference was seen in LOS based on a documented palliative care clinic visit or presence of an advanced directive. Conclusions: We identified practice based factors that need improvement including earlier goals of care conversations and less chemotherapy at the end of life. Identifying end stage patients in earlier admissions, collaborating with palliative care, and adding goals of care documentation to clinic note templates, are all interventions we are studying to improve care for end stage cancer patients.
Race, N (%) | |
White | 34 (74) |
Black | 12 (26) |
Gender | |
Male | 24 (52) |
Female | 22 (48) |
Cancer | |
Lung | 17 (37) |
Breast | 5 (11) |
Other | 24 (52) |
Chemotherapy within one month | |
Yes | 27 (59) |
No | 19 (41) |
Goals of care documented in Clinic | |
Yes | 16 (35) |
No | 30 (65) |
Stayed in ICU | |
Yes | 16 (35) |
No | 30 (65) |
Followed in Palliative Care Clinic | |
Yes | 14 (30) |
No | 32 (70) |
ECOG Status Documented | |
Yes | 23 (50) |
No | 23 (50) |
Advanced Directive | |
Yes | 11 (24) |
No | 35 (76) |
Died in hospital | |
Yes | 11 (24) |
No | 35 (76) |
Admissions in past 3 months, Median | 2 |
COS in $, Median (Q1, Q3) | 17254 (12199, 45443) |
LOS in Days, Median (Q1, Q3) | 4 (2, 9) |
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