title: Use and Predictors of End-of-Life Care Among HIV Patients in a Safety Net Health System.
abstract: BACKGROUND
  Although highly active antiretroviral therapy has improved survival among many HIV patients, there are still those with advanced illness and limited access to care who may benefit from palliative care and hospice.
  
  
  OBJECTIVE
  To examine completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital.
  
  
  METHODS
  This was a retrospective cohort study of HIV patients in a large, urban safety net hospital in 2010. Physicians abstracted data from the electronic medical record on patient and clinical factors and end-of-life care use. Logistic regression examined predictors of hospice use.
  
  
  RESULTS
  Overall, 367 HIV patients identified electronically by International Classification of Disease (ICD)-9 code were hospitalized in 2010. The mean age was 42 years, and 57% were African American. Although 28% died, only 6% of the sample received palliative care consultation, and 6% of the sample enrolled in hospice. Those who received hospice had lower albumin levels (adjusted odds ratio [AOR] 4.53, 95% CI 1.19-17.34) had received palliative care (AOR 9.73, 95% CI 2.10-45.09) and completed an advance directive (AOR 16.33, 95% CI 4.23-61.68). Of those patients who received hospice, the mean time to death after enrollment was 11 days.
  
  
  CONCLUSIONS
  Among an urban cohort of HIV patients, the rates of advance directive completion, palliative care use, and hospice use were low. Despite advancements in the treatment of HIV, many patients with advanced illness may benefit from palliative care and hospice services. Advances should be made in identifying those patients earlier in their disease trajectories.
authors.affiliation: Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. Electronic address: Ramona.Rhodes@UTSouthwestern.edu.
authors.forename: Ramona L
authors.initials: RL
authors.lastname: Rhodes
authors.affiliation: Division of Geriatric Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Fiza
authors.initials: F
authors.lastname: Nazir
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Sonya
authors.initials: S
authors.lastname: Lopez
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Xuan
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Ank E
authors.initials: AE
authors.lastname: Nijhawan
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Alexander-Scott
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data; D000418:Albumins / Q000378:metabolism; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D006738:Hospices / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D013781:Texas; D014505:Urban Population
chemical_list: D000418:Albumins
keywords: HIV; Hospice; palliative care; safety net