title: Trends in hospice discharge, documented inpatient palliative care services and inpatient mortality in ovarian carcinoma.
abstract: OBJECTIVE
  To investigate the trends in discharge to hospice, documented inpatient palliative care services, and inpatient mortality in metastatic ovarian cancer (mOvCa) patients.
  
  
  METHODS
  Patients≥18years with mOvCa and a non-elective admission between January 1, 2006 and December 31, 2011 were identified from the National Inpatient Sample (NIS). The primary outcome of interest was the temporal trend in the annual proportion of hospitalizations for mOvCa where discharge destination was hospice. Secondary outcomes included temporal trend of inpatient mortality and documented palliative care services. Multivariable logistic regression models were used to ascertain independent factors predictive of hospice discharge and documented palliative services across the clusters of hospitals.
  
  
  RESULTS
  A total of 106,203 non-elective hospitalizations were identified. The rate of hospice discharge increased from 9.2% in 2004 to 11.1% in 2011 (ptrend<0.001). Similarly, the rate of documented palliative care services increased from 2.7% in 2004 to 10.4% in 2011 (ptrend<0.001). The inpatient mortality decreased from 9.6% in 2004 to 7.4% in 2011 (ptrend<0.001). In a subset of hospitalizations with extreme risk of dying, 22% were discharged to hospice and 11% received documented palliative care services. One fifth of the patients who died in the hospital received documented palliative care services.
  
  
  CONCLUSIONS
  The use of hospice as a discharge destination and documented palliative care services is relatively low but appears to be increasing over time for mOvCa patients. Monitoring this data is vital to plan educational programs regarding palliative care approaches in this at-risk population.
authors.affiliation: Division of Gynecologic Oncology, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States. Electronic address: uppal@med.umich.edu.
authors.forename: Shitanshu
authors.initials: S
authors.lastname: Uppal
authors.affiliation: Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States.
authors.forename: Laurel W
authors.initials: LW
authors.lastname: Rice
authors.affiliation: Department of Statistics, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Anurag
authors.initials: A
authors.lastname: Beniwal
authors.affiliation: Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Spencer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006738:Hospices; D006801:Humans; D007297:Inpatients; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000628:therapy*; D010166:Palliative Care; D010351:Patient Discharge
keywords: End of life; Hospice; Inpatient mortality; Ovarian carcinoma; Palliative care