Table 2.
Adjusted Rates and Average Individual Rate Differences with Receipt of Palliative Care Consultations: Residents with Later and Earlier Initial Palliative Care (PC) Consultations (1–30 and 31–180 Days before Death, Respectively) Compared to (3 to 1) Matched Controls
| Outcomes | Rates with PC Consultations | Rates without PC Consultation | Average Individual Rate Differencesa,b with PC Consultations (95% CI) |
|---|---|---|---|
| Hospitalization in last 7 days of life (%) | |||
| Later Consultationsc | 11.6% | 20.5% | −5.9% (−13.7%, +1.9%) |
| Earlier Consultationsd–h | 4.4% | 18.3% | −13.2% (−21.8%, −4.7%) |
| Hospitalization in last 30 days of life (%) | |||
| Earlier Consultationsd–f | 7.7% | 24.5% | −18.4% (−28.5%, −8.4%) |
| ER visits in last 30 days of life (%) | |||
| Earlier Consultationsd,e | 5.5% | 17.6% | −11.9% (−20.7%, −3.1%) |
| Burdensome Transitions (%) | |||
| Later Consultationsc | 25.9% | 24.6% | −0.5% (−8.6%, +9.5%) |
| Earlier Consultationsd–f | 11.0% | 31.5% | −20.2% (−28.5%, −12.0%) |
Derived from on multivariate models controlling for the following variables, unless otherwise noted: For Residents: at baseline, age (categorized), male, marital status (married vs other), non-White, do-not-resuscitate order, do-not-hospitalize order, cancer diagnoses, activities of daily living impairment (with quadratic term), cognitive impairment, stability of cognition and functioning; days between baseline assessment and death; any hospitalizations in the 90 days prior to baseline assessment, short stay status (fewer than 90 days), and year of death. For NHs: 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 NH and nearest hospital, indicator that the percent with dementia in the facility is greater than the median in a given year, and, location of NH (Rhode Island or North Carolina).
Reflects the average of each individual’s risk difference with and without a PC consultation (average marginal effects)
Later consultations, n=112 for those with consults with 3 to 1 matched controls (with replacement)
Earlier consultations, n=91 for those with consults with 3 to 1 matched controls (with replacement)
In model the last 2 categories of age were collapsed as the last category perfectly predicted the outcome.
In model removed DNH from the model as it perfectly predicted the outcome.
In model includes the proportion non-White and presence of an Alzheimer’s unit at the NH level but does not include a person-level quadratic term for activities of daily living.
egression analyses also controlled for the presence of congestive heart disease and chronic obstructive pulmonary disease.