Table 3.

Adjusted Rates^a of Acute Care Use: Residents with Palliative Care in Differing Time Periods and Their Matched Controls

Outcomes	With PC Consult Adjusted Rate, (95% CI)	Without PC Consult Adjusted Rate, (95% CI)	P-value
Hospitalization in last 7 days of life
Days between death and initial PC visit
≤ 7 daysb	20.8 (16.93 to 24.65)	36.0 (32.97 to 38.97)	.008
8–30 days	11.1 (9.79 to 12.43)	22.0 (20.62 to 23.41)	.002
31–60 daysc	13.1 (10.45 to 15.74)	21.4 (18.81 to 24.05)	.138d
61–180 days	6.9 (5.47 to 8.37)	22.9 (20.48 to 25.42)	<.001
Hospitalization in last 30 days of life
Days between death and initial PC visit
31–60 days	22.6 (18.61 to 26.63)	32.9 (30.15 to 35.72)	.069
61–180 days	15.4 (12.58 to 18.19)	30.6 (27.80 to 33.49)	<.001
Hospitalization in last 60 days
Days between death and initial PC visit
61–180 days	26.9 (22.99 to 30.86)	40.1 (36.98 to 43.28)	.003
ER visits in last 30 days of life
Days between death and initial PC visit
31–60 days	8.3 (5.45 to 11.21)	15.9 (13.39 to 18.36)	.023
61–180 dayse,f	10.8 (8.50 to 13.03)	14.4 (12.51 to 16.21)	.504
ER visits in last 60 days of life
Days between death and initial PC visit
61–180 daysf	16.2 (13.45 to 18.86)	20.3 (18.27 to 22.24)	.265
Burdensome Transitions
Days between death and initial PC visit
≤ 7 daysb	41.6 (36.47 to 46.69)	41.6 (38.10 to 45.07)	.995
8–30 days	28.4 (25.77 to 31.02)	25.9 (24.32 to 27.54)	.638
31–60 daysg	22.6 (19.41 to 25.82)	26.6 (24.40 to 28.78)	.275
61–180 days	16.2 (13.74 to 18.57)	28.2 (25.82 to 30.59)	.004

Abbreviations: PC, palliative care; ER, emergency room

^aAdjusted rates based on multivariate models controlling for the following variables, unless otherwise noted: For Residents: at baseline, age, marital status, non-White, do-not-resuscitate order, do-not-hospitalize order, 4-category dementia/cancer diagnoses, activities of daily living impairment, cognitive impairment, stability of cognition and functioning; days between baseline assessment and death; 1 or 2 or more hospitalizations in the 90 days prior to baseline assessment and year of death. For nursing homes: percent non-White, resident casemix, chain affiliation, profit status, employment of any nurse practitioner and/or physician assistant, proportion of residents on Medicare or Medicaid as primary payer, distance between nursing home and nearest hospital; and, location of nursing home (Rhode Island or North Carolina).

^bModels did not include non-White, percent non-White, and 2 or more hospitalizations in 90 days prior to baseline assessment.

^cDo-not-resuscitate order was removed from the model because it predicted the outcome perfectly.

^dP-values do not perfectly coincide with 95% CI because p-values were generated from the predicted probabilities while the p-value was taken from the palliative consult estimate of the multivariate model.

^eCognitive impairment was removed from the model because it predicted the outcome perfectly.

^fThe 4-category dementia/cancer variable was removed from the model because it predicted the outcome perfectly. Dichotomous measures of dementia and cancer were added.

^gTo achieve model fit, this model did not include non-White, percent non-White, profit status, or presence of a Do-Not-Resuscitate order. It also replaced the 4-category dementia/cancer variable with dichotomous measure of dementia and cancer; collapsed categories of time from baseline assessment to death, year of death, and cognitive status; and added a quadratic term for distance from nursing home to the nearest hospital.