Integrative palliative care, advance directives, and hospital outcomes of critically ill older adults.
OBJECTIVE
To examine the associations between palliative care types and hospital outcomes for patients who have or do not have advance directives.


METHODS
Using administrative claims and clinical data for critically ill older adults (n = 1291), multivariable regressions examined the associations between palliative care types and hospital outcomes by advance directive status.


RESULTS
Integrative palliative care was associated with lower hospital costs, lower adjusted probability of in-hospital deaths, and higher adjusted probability of hospice discharges. There was no difference in hospital outcomes by palliative care types in those with advance directives.


CONCLUSIONS
Significantly lower hospital costs and in-hospital deaths with higher hospice discharges were observed in integrative palliative care compared to consultative palliative care, but these findings were diminished with the presence of advance directives.
1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA. yoojiw@trinity-health.org
Ji Won
JW
Yoo
Shunichi
S
Nakagawa
Sulgi
S
Kim
D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome