Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life.
OBJECTIVE
There has been increased attention on ways to improve the quality of end-of-life care for patients with end-stage liver disease; however, there have been few reports of care experiences for patients during terminal hospitalizations. We analyzed data from a large national database to increase our understanding of palliative care for and health care utilization by patients with end-stage liver disease.


METHODS
We performed a cross-sectional, observational study to examine terminal hospitalizations of adults with decompensated cirrhosis using data from the National Inpatient Sample from 2009 through 2013. We collected data on palliative care consultation and total hospital costs, and performed multivariate regression analyses to identify factors associated with palliative care consultation. We also investigated whether consultation was associated with lower costs.


RESULTS
Among hospitalized adults with terminal decompensated cirrhosis, 30.3% received palliative care; the mean cost per hospitalization was $48,551 ± $1142. Palliative care consultation increased annually, and was provided to 18.0% of patients in 2009 and to 36.6% of patients in 2013 (P < .05). The mean cost for the terminal hospitalization did not increase significantly ($47,969 in 2009 to $48,956 in 2013, P = .77). African Americans, Hispanics, Asians, and liver transplant candidates were less likely to receive palliative care, whereas care in large urban teaching hospitals was associated with a higher odds of receiving consultation. Palliative care was associated with lower procedure burden-after adjusting for other factors, palliative care was associated with a cost reduction of $10,062.


CONCLUSIONS
Palliative care consultation for patients with end-stage liver disease increased from 2009 through 2013. Palliative care consultation during terminal hospitalizations is associated with lower costs and procedure burden. Future research should evaluate timing and effects of palliative care on quality of end-of-life care in this population.
Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California. Electronic address: ArpanPatel@mednet.ucla.edu.
Arpan A
AA
Patel
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
Anne M
AM
Walling
UCLA Institute for Digital Research and Education (IDRE), Statistical Consulting Group, Los Angeles, California.
Joni
J
Ricks-Oddie
Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
Folasade P
FP
May
Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.
Sammy
S
Saab
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California.
Neil
N
Wenger
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D058625:End Stage Liver Disease / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D055815:Young Adult
Death; HCC; NIS; Palliation