New Findings from Department of Medicine in the Area of Palliative and Supportive Care Reported (Characterization, Categorization, and 5-Year…

New Findings from Department of Medicine in the Area of Palliative and Supportive Care Reported (Characterization, Categorization, and 5-Year Mortality of Medicine High Utilizer Inpatients)

By a News Reporter-Staff News Editor at Clinical Trials Week -- Current study results on Palliative and Supportive Care have been published. According to news reporting out of New York City, New York, by NewsRx editors, research stated, "Patients who are frequently admitted to Medicine inpatient services comprise a distinct subset of readmitted patients about whom not much is known. We sought to characterize this group including mortality rates, with the goal of better understanding this population."

Our news journalists obtained a quote from the research from the Department of Medicine, "Observational study of frequently hospitalized patients defined as 4 or more admissions over a 6-month period, with hospitalization defined as nonelective admission to the hospital. Single large academic medical center. Adult inpatients on general medicine and medicine subspecialty services. The number of nonelective medicine hospitalizations, age, clinical conditions and comorbidities, calculation of an age-adjusted Charlson Comorbidity Index (CCI), outpatient and emergency department visits, length of stay, costs of hospitalization, and mortality over a 5-year period. Descriptive statistics were used to characterize variables of interest. We identified 153 patients with a total of 781 nonelective hospitalizations, totaling greater than 4000 hospital days and with charges of approximately US$9 million during the 6 months. Nearly all had insurance coverage and good outpatient follow-up (median of 7 appointments over the 6-month study period). Only 14% of those admissions qualified for observation status. Over 40% of patients had comorbid mental health disease or chronic narcotic dependence. Twenty-nine percent of patients died within 1 year; 50% were dead within 5 years. Age-adjusted CCI scores ranged annually from 3.00 to 3.58 among surviving patients versus 4.31 to 6.60 among deceased patients. These findings point to distinct groups of patients who are frequently hospitalized, and therefore would benefit from tailored management strategies: Those with progression of end-stage disease comprised one-third of the group and targeting that subset with palliative care referrals could help decrease readmission rates. Those with recurrent exacerbations of a chronic medical condition could be managed through telemanagement programs. Those with exacerbations of chronic pain could be addressed through collaboration with pain management specialists. Individualized care management plans may be useful for all, especially the latter two groups."

According to the news editors, the research concluded: "Based on differences between survivors and deceased patients, an age-adjusted CCI score of 4 or 5 could be valuable sensitive or specific cutoffs, respectively, for predicting those who would benefit most from palliative care consultation regarding end-of-life goals and management."

For more information on this research see: Characterization, Categorization, and 5-Year Mortality of Medicine High Utilizer Inpatients. Journal of Palliative Care, 2018;():825859718769095. Journal of Palliative Care can be contacted at: Center Bioethics Clin RES Inst Montreal, 110 Pine Ave W, Montreal, Quebec H2W 1R7, Canada (see also Palliative and Supportive Care).

Our news journalists report that additional information may be obtained by contacting J.G. Dastidar, 1 Division of General Medicine, Dept. of Medicine, Section of Hospital Medicine, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, United States.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1177/0825859718769095. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

Publisher contact information for the Journal of Palliative Care is: Center Bioethics Clin RES Inst Montreal, 110 Pine Ave W, Montreal, Quebec H2W 1R7, Canada.

Keywords for this news article include: Hospitals, New York City, United States, Health and Medicine, North and Central America, Palliative and Supportive Care.

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