title: Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen: National Trends and Barriers to Care in the United States.
abstract: BACKGROUND
  To investigate the use of palliative care (PC) in patients with end-stage COPD receiving home oxygen hospitalized for an exacerbation.
  
  
  METHODS
  A retrospective nationwide cohort analysis was performed, using the Nationwide Inpatient Sample. All patients ≥ 18 years of age with a diagnosis of COPD, receiving home oxygen, and admitted for an exacerbation were included.
  
  
  RESULTS
  A total of 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Sample were examined. There were 181,689 patients with COPD, receiving home oxygen, and admitted for an exacerbation; 3,145 patients (1.7%) also had a PC contact. There was a 4.5-fold relative increase in PC referral from 2006 (0.45%) to 2012 (2.56%) (P < .01). Patients receiving PC consultations compared with those who did not were older (75.0 years [SD 10.9] vs 70.6 years [SD 9.7]; P < .01), had longer hospitalizations (4.9 days [interquartile range, 2.6-8.2] vs 3.5 days [interquartile range, 2.1-5.6]), and more likely to die in hospital (32.1% vs 1.5%; P < .01). Race was significantly associated with referral to palliative care, with white patients referred more often than minorities (P < .01). Factors associated with PC referral included age (OR, 1.03; 95% CI, 1.02-1.04; P < .01), metastatic cancer (OR, 2.40; 95% CI, 2.02-2.87; P < .01), nonmetastatic cancer (OR, 2.75; 95% CI, 2.43-3.11; P < .01), invasive mechanical ventilation (OR, 4.89; 95% CI, 4.31-5.55; P < .01), noninvasive mechanical ventilation (OR, 2.84; 95% CI, 2.58-3.12; P < .01), and Do Not Resuscitate status (OR, 7.95; 95% CI, 7.29-8.67; P < .01).
  
  
  CONCLUSIONS
  The use of PC increased dramatically during the study period; however, PC contact occurs only in a minority of patients with end-stage COPD admitted with an exacerbation.
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA. Electronic address: bar890@mail.harvard.edu.
authors.forename: Barret
authors.initials: B
authors.lastname: Rush
authors.affiliation: Division of General Internal Medicine, University Health Network, Toronto, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Hertz
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bond
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: McDermid
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000706:statistics & numerical data; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
keywords: United States; chronic obstructive pulmonary disease; home oxygen; palliative care