Table 2.
Outcomes of Triggered Palliative Care for Persons with Late-stage Dementia.
| Intervention N=30 |
Control N=32 |
||
|---|---|---|---|
| Outcomes | P value | ||
| Primary Outcome | 60 d | 60 d | |
| Hospital / emergency visits per 60 days (no. of events/follow-up days) |
0.68 (21/1843) | 0.53 (20/2264) | 0.415 |
| Patient and Family Centered Secondary Outcomes | |||
| Patient comfort (CAD-EOLD*), mean (SD) (range 14–42) | 34.8 (4.2) | 34.0 (4.1) | 0.521 |
| Family caregiver distress (FDAD**), mean (SD) (range 1–5) | 2.3 (0.5) | 2.4 (0.5) | 0.409 |
| Palliative Care Domain Index (0–10) in hospital care plan | 7.6 (2.5) | 2.7 (1.7) | <0.001 |
| Physical symptom addressed | |||
| Pain | 87% | 72% | 0.153 |
| Dyspnea | 77% | 34% | <0.001 |
| Constipation | 93% | 25% | <0.001 |
| Poor appetite | 37% | 38% | 0.946 |
| Nausea | 90% | 25% | <0.001 |
| Falls | 33% | 16% | 0.104 |
| Neuropsychiatric symptom addressed | |||
| Depression | 83% | 25% | <0.001 |
| Anxiety | 83% | 16% | <0.001 |
| Decreased level of consciousness | 67% | 22% | <0.001 |
| Hyperactive delirium | 80% | 19% | <0.001 |
| Spiritual needs addressed | 47% | 0% | <0.001 |
| Hospice at 60 days | 25% | 3% | 0.019 |
| Community Palliative Care at 60 days | 21% | 7% | 0.124 |
| Hospital discharge location | |||
| Home | 33% | 25% | 0.046 |
| Assisted living | 24% | 3% | |
| Nursing home | 33% | 63% | |
| Death | 0% | 0% | |
| Other | 10% | 9% | |
| Patient vital status alive at 60 days, % | 87% | 94% | 0.346 |
| Decision-making Secondary Outcomes | |||
| Documented discussion of prognosis, % YES | 90% | 3% | <0.001 |
| Documented discussion of goals of care, % YES | 90% | 25% | <0.001 |
| MOST+ completion at 60 days | 79% | 30% | <0.001 |
| Code status in hospital | |||
| Full code | 27% | 22% | 0.583 |
| DNR, present at admission | 53% | 66% | |
| DNR, new | 20% | 12% | |
| Decision not to re-hospitalize | 13% | 0% | 0.033 |
| Decision made NOT to tube feed | 53% | 6% | <0.001 |
| Decision made NOT to use antibiotics | 7% | 3% | <0.001 |
| Decision made to LIMIT use of antibiotics | 43% | 0% | |
| Decision made NOT to use IV fluids | 13% | 6% | <0.001 |
| Decision made to LIMIT use of IV fluids | 43% | 3% | |
| Dementia Care Quality Metrics (chart review) | |||
| Dementia staged | 93% | 9% | <0.001 |
| Cognitive assessment | 73% | 9% | <0.001 |
| Functional assessment | 97% | 25% | <0.001 |
| Neuropsychiatric symptoms addressed | 83% | 25% | <0.001 |
| Safety concerns addressed | 83% | 44% | 0.001 |
| Caregiver education | 80% | 25% | <0.001 |
*
CAD-EOLD=Comfort Assessment in Dying, End of Life in Dementia, range overall 14–42, higher scores indicate more comfort
**
FDAD=Family Distress in Advanced Dementia, range overall and subscales 1–5, higher scores indicate more distress
+
MOST=Medical Orders for Scope of Treatment, the North Carolina version of POLST (Physician Orders for Life Sustaining Treatment) order set