Cargando…

Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life

Background: Previous research mostly analyzed the utilization of palliative care for patients with cancer, and data regarding non-cancer inpatients are limited. Objectives: This research aimed to investigate the current situation regarding palliative care and the important factors that influence its...

Descripción completa

Detalles Bibliográficos
Autores principales: Lin, Hui-Mei, Liu, Chih-Kuang, Huang, Yen-Chun, Chen, Ming-Chih
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8998871/
https://www.ncbi.nlm.nih.gov/pubmed/35409941
http://dx.doi.org/10.3390/ijerph19074263
_version_ 1784685046671605760
author Lin, Hui-Mei
Liu, Chih-Kuang
Huang, Yen-Chun
Chen, Ming-Chih
author_facet Lin, Hui-Mei
Liu, Chih-Kuang
Huang, Yen-Chun
Chen, Ming-Chih
author_sort Lin, Hui-Mei
collection PubMed
description Background: Previous research mostly analyzed the utilization of palliative care for patients with cancer, and data regarding non-cancer inpatients are limited. Objectives: This research aimed to investigate the current situation regarding palliative care and the important factors that influence its utilization by inpatients (including inpatients with and without cancer) at the end of their lives. We also explored the feasibility of establishing a prediction model of palliative care utilization for inpatients at the end of their lives. These findings will allow medical staff to monitor and focus on those who may require palliative care, resulting in more end-of-life patients receiving palliative care and thereby reducing medical expense and improving their quality of life. Methods: This was a retrospective study based on real-world health information system (HIS) data from 5 different branches of Taipei City Hospital between 1 January 2018 and 31 December 2018 that enrolled a total of 1668 deceased inpatients. To explore palliative care utilization at the end of life, we used 5-fold cross-validation in four different statistical models to obtain the performance of predictive accuracy: logistic regression (LGR), classification and regression tree (CART), multivariate adaptive regression spline (MARS), and gradient boosting (GB). The important variables that may affect palliative care utilization by inpatients were also identified. Results: The results were as follows: (1) 497 (29.8%) inpatients received palliative care; (2) the average daily hospitalization cost of patients with cancer who received palliative care (NTD 5789 vs. NTD 12,115; p ≤ 0.001) and all patients who received palliative care (NTD 91,527 vs. NTD 186,981; p = 0.0037) were statistically significantly lower than patients who did not receive palliative care; (3) diagnosis, hospital, and length of stay (LOS) may affect palliative care utilization of inpatient; diagnosis, hospitalization unit, and length of hospitalization were statistically significant by LGR; (4) 51.5% of patients utilized palliative consultation services, and 48.5% utilized palliative care units; and (5) MARS had the most consistent results; its accuracy was 0.751, and the main predictors of palliative care utilization are hospital, medical expense, LOS, diagnosis, and Palliative Care Screening Tool-Taiwan version (TW-PCST) scores. Conclusions: The results reveal that palliative care utilization by inpatients remains low, and it is necessary to educate patients without cancer of the benefits and advantages of palliative care. Although data were limited, the predictability of the MARS model was 0.751; a better prediction model with more data is necessary for further research. Precisely predicting the need for palliative care may encourage patients and their family members to consider palliative care, which may balance both physical and mental care. Therefore, unnecessary medical care can be avoided and limited medical resources can be allocated to more patients in need.
format Online
Article
Text
id pubmed-8998871
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-89988712022-04-12 Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life Lin, Hui-Mei Liu, Chih-Kuang Huang, Yen-Chun Chen, Ming-Chih Int J Environ Res Public Health Article Background: Previous research mostly analyzed the utilization of palliative care for patients with cancer, and data regarding non-cancer inpatients are limited. Objectives: This research aimed to investigate the current situation regarding palliative care and the important factors that influence its utilization by inpatients (including inpatients with and without cancer) at the end of their lives. We also explored the feasibility of establishing a prediction model of palliative care utilization for inpatients at the end of their lives. These findings will allow medical staff to monitor and focus on those who may require palliative care, resulting in more end-of-life patients receiving palliative care and thereby reducing medical expense and improving their quality of life. Methods: This was a retrospective study based on real-world health information system (HIS) data from 5 different branches of Taipei City Hospital between 1 January 2018 and 31 December 2018 that enrolled a total of 1668 deceased inpatients. To explore palliative care utilization at the end of life, we used 5-fold cross-validation in four different statistical models to obtain the performance of predictive accuracy: logistic regression (LGR), classification and regression tree (CART), multivariate adaptive regression spline (MARS), and gradient boosting (GB). The important variables that may affect palliative care utilization by inpatients were also identified. Results: The results were as follows: (1) 497 (29.8%) inpatients received palliative care; (2) the average daily hospitalization cost of patients with cancer who received palliative care (NTD 5789 vs. NTD 12,115; p ≤ 0.001) and all patients who received palliative care (NTD 91,527 vs. NTD 186,981; p = 0.0037) were statistically significantly lower than patients who did not receive palliative care; (3) diagnosis, hospital, and length of stay (LOS) may affect palliative care utilization of inpatient; diagnosis, hospitalization unit, and length of hospitalization were statistically significant by LGR; (4) 51.5% of patients utilized palliative consultation services, and 48.5% utilized palliative care units; and (5) MARS had the most consistent results; its accuracy was 0.751, and the main predictors of palliative care utilization are hospital, medical expense, LOS, diagnosis, and Palliative Care Screening Tool-Taiwan version (TW-PCST) scores. Conclusions: The results reveal that palliative care utilization by inpatients remains low, and it is necessary to educate patients without cancer of the benefits and advantages of palliative care. Although data were limited, the predictability of the MARS model was 0.751; a better prediction model with more data is necessary for further research. Precisely predicting the need for palliative care may encourage patients and their family members to consider palliative care, which may balance both physical and mental care. Therefore, unnecessary medical care can be avoided and limited medical resources can be allocated to more patients in need. MDPI 2022-04-02 /pmc/articles/PMC8998871/ /pubmed/35409941 http://dx.doi.org/10.3390/ijerph19074263 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lin, Hui-Mei
Liu, Chih-Kuang
Huang, Yen-Chun
Chen, Ming-Chih
Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life
title Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life
title_full Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life
title_fullStr Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life
title_full_unstemmed Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life
title_short Exploratory Study of Palliative Care Utilization and Medical Expense for Inpatients at the End-of-Life
title_sort exploratory study of palliative care utilization and medical expense for inpatients at the end-of-life
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8998871/
https://www.ncbi.nlm.nih.gov/pubmed/35409941
http://dx.doi.org/10.3390/ijerph19074263
work_keys_str_mv AT linhuimei exploratorystudyofpalliativecareutilizationandmedicalexpenseforinpatientsattheendoflife
AT liuchihkuang exploratorystudyofpalliativecareutilizationandmedicalexpenseforinpatientsattheendoflife
AT huangyenchun exploratorystudyofpalliativecareutilizationandmedicalexpenseforinpatientsattheendoflife
AT chenmingchih exploratorystudyofpalliativecareutilizationandmedicalexpenseforinpatientsattheendoflife