title: Outpatient end of life discussions shorten hospital admissions in gynecologic oncology patients.
abstract: OBJECTIVE
  The study goal was to determine whether prior outpatient exposure to hospice discussion altered the inpatient course and end-of-life (EOL) care among patients ultimately discharged to hospice.
  
  
  METHODS
  Medical records from January 2009 to June 2012 were reviewed and data were abstracted under an IRB-approved protocol. Hospice discussions were identified in the last outpatient clinical encounter prior to admission. Kaplan-Meier was used to estimate overall survival (OS) and the log-rank test was used to test for differences.
  
  
  RESULTS
  There were 89 hospitalizations resulting in discharge to hospice care: 41 women with ovarian (46%), 23 with uterine (29%), 19 with cervical (21.3%), and with 6 vulvar/vaginal (6.7%) cancers. 83 patients (93%) had outpatient clinical encounters prior to admission;18% (15/83) were exposed to a hospice discussion (HD) and 82% (68/83) were not (NHD). Median time from last outpatient encounter was 18 days (range 0-371). NHD patients had longer inpatient length of stay (median 7 days vs. 4 days, p=0.008) and were less likely to receive palliative care consults than the HD patients (65% vs. 93%, p=0.03). Median OS for HD patients was 33 days (95% CI 22d-61 d) vs. 60 days (95% CI 49 d-84 d) for NHD patients (p=0.01). There were no differences detected based on race, ethnicity, or insurance status.
  
  
  CONCLUSIONS
  HD patients had significantly shorter OS suggesting that providers were accurate in identifying patients nearing the EOL. Patients exposed to outpatient hospice discussions had a shorter length of stay and increased utilization of palliative care resources.
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, United States. kmdoll@unch.unc.edu
authors.forename: Kemi M
authors.initials: KM
authors.lastname: Doll
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Stine
authors.forename: Linda
authors.initials: L
authors.lastname: Van Le
authors.forename: Dominic T
authors.initials: DT
authors.lastname: Moore
authors.forename: Victoria
authors.initials: V
authors.lastname: Bae-Jump
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Brewster
authors.forename: John T
authors.initials: JT
authors.lastname: Soper
authors.forename: John F
authors.initials: JF
authors.lastname: Boggess
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology* / Q000628:therapy*; D006738:Hospices / Q000379:methods / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010045:Outpatients; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013727:Terminal Care / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*