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A5089 - Latent Class Analysis of Specialized Palliative Care Utilization in Adult Intensive Care Units from a Single Academic Medical Center
Author Block: D. Wang1, C. Ing1, C. Blinderman2, M. Hua1; 1Anesthesiology, Columbia University Medical Center, New York, NY, United States, 2Pain and Palliative Care, Columbia University Medical Center, New York, NY, United States.
Rationale: In the intensive care unit (ICU), approximately 14% of patients meet criteria for specialized palliative care. However, palliative care consults may focus on different aspects of patient care, ranging from symptom management to goals of care. It is unclear whether subgroups of critically ill patients differ in their palliative care needs, and whether these differences are associated with outcomes.
Methods: We conducted a retrospective cohort study of all ICU patients in a single academic medical center that received specialized palliative care from August 2013 - August 2015. The reason for palliative care consultation was directly extracted from the initial consultation note and included symptom management, pain management, goals of care, prognostication, withdrawal of life-sustaining therapy, discharge planning, advance directives, hospice referral and supportive care. These reasons were entered into a latent class analysis (LCA) model to generate mutually exclusive classes of patients. We examined differences in demographic and clinical characteristics and outcomes between classes using appropriate bivariate testing. We also examined differences in “high use” of palliative care between classes (defined as having ≥ 5 visits by the palliative care team) using logistic regression.
Results: In a sample of 689 patients, a four-class model provided the best fit with four clinically meaningful groups identified: 1) pain and symptom management (n=218, 31.6%), 2) goals of care and advance directives (GCAD) (n=131, 19.0%), 3) all needs (n=112, 16.3%) and 4) supportive care (n=228, 33.1%). There were no significant differences in age, sex, race or hospital length of stay between classes. Compared to the GCAD class of patients, patients with all needs were less likely to be discharged home (36.6% vs. 17.9%, p=0.004), and more likely to require “high use” of palliative care (19.1% vs. 35.7%, p=0.03). This difference persisted after adjustment for hospital length of stay; compared to GCAD patients, all other classes were more likely to require “high use” of palliative care, (odds ratio (OR) 2.76, [1.52-5.06] for all needs, OR 2.02 [1.18-3.45] for supportive care, OR 1.98 [1.15-3.40] for pain and symptom management).
Conclusion: Based on the initial reason for consultation, we identified four different classes of “palliative care need” amongst critically ill patients. The GCAD class of patients were least likely to be high-utilizers of specialized palliative care. These findings may help to delineate the burden of palliative care needs in critically ill patients at the time of initial consultation and inform allocation of palliative care resources.