title: Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil.
abstract: Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.
authors.affiliation: 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil.
authors.forename: Luiz Guilherme L
authors.initials: LGL
authors.lastname: Soares
authors.affiliation: 2 Instituto Nacional de Infectologia-Fundação Oswaldo Cruz, Research Laboratory of Intensive Care Medicine, Niterói, Rio de Janeiro, Brazil.
authors.forename: André M
authors.initials: AM
authors.lastname: Japiassu
authors.affiliation: 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil.
authors.forename: Lucia C
authors.initials: LC
authors.lastname: Gomes
authors.affiliation: 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil.
authors.forename: Rogéria
authors.initials: R
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D010351:Patient Discharge; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000458:organization & administration*
keywords: discharge planning; palliative care; post-acute care