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APHA Scientific Session and Event Listing

Yosef Dlugacz, PhD, Lori Stier, EdD, Susan Delosh, RN, and Roshan Hussain, MPH. Quality Management, North Shore-Long Island Jewish Health System, 145 Community Dr, Great Neck, NY 11021, 516-465-8293, rhussain@nshs.edu

Objective: Palliative Care (PC) establishes goals of care, advance directives, and improves access to hospice care. Physicians play a vital role in the selection and referral of potential patients for Palliative Care services. The aim of this study is to evaluate whether or not physicians refer patients who are truly at end of life to PC, by comparing severity and outcomes of patients who were selected for palliative care versus those who were not. Methodology: APACHE III data from January-September 2005 were analyzed. This study compares North Shore University Hospital (NSUH) MICU patients, who received PC Consults (N=182) (i.e., PC Consult Patients), to NSUH MICU Patients, who did not receive a PC Consult (N=653) (Non-PC Patients), in terms of severity and outcomes using APACHE III methodology. Specifically, the dimensions of severity are Apache III Score, Predictive Length of Stay, and Predictive Mortality Rate. Outcomes of care are defined as mortality, DNR status, and discharge disposition (of those who are alive at hospital discharge). Results: PC Consult Patients were significantly more severe (across all dimensions) (p<.001) and were significantly more likely to die in the MICU (46.2% vs. 15.5%) or on the hospital floor (31.9% vs. 14.1%) than their counterparts (p<.001); while a significantly higher proportion of Non-PC Patients (70.4%) were discharged alive than PC Consult Patients (22.0%). Additionally, the percent of DNRs after ICU admission was significantly higher for PC Consult Patients than the Non-PC Patients (67.6% vs. 18.4%; p<.001). Of those patients who were discharged alive (N=34 [PC Consult Patients]; N=424 [Non-PC Patients]), a significantly greater portion of PC Consult patients were discharged to Hospice (17.6% vs. 2.1%; p<.001) and Skilled Nursing Facilities (52.9% vs. 31.1%; p=.009) than Non-PC Patients. Conversely, Non-PC Patients were significantly more likely to be discharged home (62.3% vs. 23.5%) than patients who received a PC Consult (p<.001). Conclusions: Physicians are appropriately referring severe patients that are at end of life to PC. Moreover, the clinician's perception of severity, which is grounded in practice, is in line with the objective and quantifiable dimensions of severity (i.e., APACHE III Score and associated predictions). The other important implication of this study is that APACHE III may have the ability to select patients for PC in conjunction or in lieu of the clinician. APACHE III may provide an organization process advantage (i.e., increased efficiency and efficacy) in placing patients at the appropriate level of care.

Learning Objectives:

• Describe the severity and outcomes associated with end of life ICU patients.
• Evaluate physician selection and referral of end of life patients to Palliative Care.
• Assess patient selection using APACHE III.
• Articulate the importance of appropriate level of care for end of life patients.

Keywords: End-of-Life Care, Evaluation

Presenting author's disclosure statement:

Not Answered