Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness

Little is known about psychiatric illness and utilization of end-of-life care. We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. We reviewed...

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Vydáno v:	Journal of pain and symptom management Ročník 54; číslo 2; s. 176 - 185.e1
Hlavní autoři:	Lavin, Kyle, Davydow, Dimitry S., Downey, Lois, Engelberg, Ruth A., Dunlap, Ben, Sibley, James, Lober, William B., Okimoto, Kelson, Khandelwal, Nita, Loggers, Elizabeth T., Teno, Joan M., Curtis, J. Randall
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Elsevier Inc 01.08.2017 Elsevier Limited
Témata:	Acute services Anesthesia & Perioperative Care Chronic Disease - mortality Chronic Disease - psychology Chronic Disease - therapy Chronic illnesses Classification Cohort Studies Computerized medical records Critical Care - utilization Death & dying Disease Emergency Medical Services - utilization Emergency services End of life decisions end-of-life care Epidemiology Female Health records Health services Hospice care Hospitalization Hospitals Humans Illnesses Intensive care Knowledge utilization Life Male Medical conditions Medical records Mental disorders Mental Disorders - complications Mental Disorders - mortality Mental Disorders - therapy Mental health Middle Aged Morbidity multimorbidity Nursing homes Pain Medicine Palliative care Palliative Care - psychology Palliative Care - utilization Patients psychiatric illness Psychiatric-mental health nursing Regression Analysis Risk Factors Segmentation Severity Severity of Illness Index Terminal Care - psychology Terminal Care - utilization Palliative care multimorbidity epidemiology psychiatric illness end-of-life care
ISSN:	0885-3924, 1873-6513, 1873-6513
On-line přístup:	Získat plný text
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Shrnutí:	Little is known about psychiatric illness and utilization of end-of-life care. We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases–9 codes. We used International Classification of Diseases–9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0885-3924 1873-6513 1873-6513
DOI:	10.1016/j.jpainsymman.2017.04.003