Abstract W MP101: Palliative Care Consultations for Stroke Patients in Washington State
Background: Patients with stroke have a high risk of death, physical and cognitive impairments and therefore have a high degree of palliative care (PC) needs. The goal of this study is to explore the prevalence of and associations with PC consultation in stroke patients.
Methods: Using the administrative hospital discharge database of Washington State, we reviewed all patients discharged with stroke (based on ICD-9 codes) from 2009-2011. Strokes were subclassified as ischemic, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). We collected information on demographics, outcome and presence of a “Palliative Care encounter” as defined by the ICD-9 code V66.7.
Results: Overall, there were 33102 stroke patients with a mean age of 71.1 (SD 16), 52% were female and 49% white. The majority of patients had ischemic strokes (28581, 86%) followed by ICH (9.6%) and SAH (4%). A PC encounter was found in 1682 patients (5%) and was more common in patients with older age, hemorrhagic stroke types, those discharged from larger hospitals and in more recent years (all p<0.05). A trend for higher rate of PC encounters was found for women (OR 0.89, 95% CI 0.77-1.02). For those patients where race data was available, blacks and Hawaiian/Pacific Islanders had less use of PC than whites (all p <0.05). One tenth of patients died in hospital (n=3327), only one third of which (n=1024) received a PC encounter. PC encounter was significantly associated with hospital death, and led to a shorter length of stay in those who died (4.5 days, 95% CI 4.2-4.8 vs. 6.6 days, 95% CI 6.2 vs. 7.0, p < 0.05).
Conclusions: PC encounters are becoming more common for stroke patients, especially in larger hospitals and are strongly associated with hospital death (i.e. more commonly used in more severe strokes). The unequal distribution across age, gender, stroke type and race suggests a need for more standardized methods to identify patients’ need for PC consultation such as validated PC consultation triggers.
Author Disclosures: C. Creutzfeldt: None. A. Huffer: None. R. Kalani: None. D.L. Tirschwell: None.
- © 2015 by American Heart Association, Inc.