title: Determinants of Palliative Care Utilization Among Patients Hospitalized With Metastatic Gastrointestinal Malignancies.
abstract: BACKGROUND
  Gastrointestinal tract cancers account for a significant proportion of the national cancer burden.
  
  
  OBJECTIVE
  We sought to explore patient- and hospital-level determinants of palliative care utilization among patients hospitalized with metastatic gastrointestinal tract cancers using a national database.
  
  
  METHODS
  An analysis of the 2012 National Inpatient Sample was performed. International Classification of Diseases, Ninth Revision codes were used to identify hospital discharges associated with metastatic digestive tract cancers and patient/hospital covariates for inclusion in a logistic regression model. Total charges and length of stay were analyzed in a linear regression model.
  
  
  RESULTS
  Compared to males, females were more likely to receive inpatient palliative care (adjusted odds ratio [OR] 1.12, P = .002). No difference was seen between white and Asian patients (adjusted OR 1.2, P = .11) or Native Americans patients (adjusted OR 1.4, P = .22). However, relative to white patients, African Americans (adjusted OR 1.13, P = .02) and Hispanics (adjusted OR 1.25, P = .001) had significantly higher odds of inpatient palliative care. Medicare patients were least likely to receive palliative care compared to those with Medicaid or commercial payers. Length of stay during these hospitalizations was longer in African Americans ( P = .0001), Asians ( P = .0001), and Native Americans ( P = .03) compared to white patients. No difference was seen when total charges were compared between white and African American patients ( P = .08). Conversely, total charges were higher in Hispanics ( P = .005) and Asians ( P = .001) relative to white patients.
  
  
  CONCLUSIONS
  Gender and racial differences exist in utilization of inpatient palliative care among patients hospitalized with metastatic gastrointestinal tract cancers.
authors.affiliation: 1 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Okafor
authors.affiliation: 2 North Shore University Health System, Skokie, IL, USA.
authors.forename: Derrick J
authors.initials: DJ
authors.lastname: Stobaugh
authors.affiliation: 3 Department of Medicine, Saint Joseph Hospital, Chicago, IL, USA.
authors.forename: Augustine K
authors.initials: AK
authors.lastname: Nnadi
authors.affiliation: 1 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.|4 Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jayant A
authors.initials: JA
authors.lastname: Talwalkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000706:statistics & numerical data*; D000070659:Patient Comfort; D012189:Retrospective Studies; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D014481:United States
keywords: end-of-life care; gastrointestinal oncology; outcomes research