Institutional Variation in Specialty Palliative Care Consultation Among Patients With Persistent Critical Illness: A Cohort Study.

ABSTRACT:

Background

Development of persistent critical illness (PerCI) necessitating prolonged ICU stays varies across hospitals. Specialty palliative care consultation may mitigate PerCI development by influencing the transition to comfort-directed care when appropriate.

Research question

Do hospitals with the lowest rates of PerCI have higher use of specialty palliative care consultations during the first 3 days of admission to the ICU as compared with hospitals with the highest rates of PerCI?

Study design and methods

This was a retrospective cohort of veterans admitted to Veterans Affairs (VA) ICUs from October 2015 through December 2021. PerCI was defined as an ICU length of stay of at least 11 days. We used multilevel logistic regression to assess cross-hospital variation in risk-adjusted and reliability-adjusted probabilities of PerCI developing. We subsequently classified hospitals into quintiles of adjusted probabilities of PerCI and assessed incidence and timing of new specialty palliative care consultations by quintile. In sensitivity analyses, we assessed correlations between hospital-level incidence of early specialty palliative care consultation and adjusted probability of PerCI developing.

Results

Among 371,280 ICU hospitalizations at 104 VA hospitals, 5.4% of patients (n = 19,904 of 371,280) experienced PerCI and 4.8% underwent an early specialty palliative care consultation. In adjusted models, development of PerCI ranged from 1.4% (lowest-quintile hospitals) to 5.4% (highest-quintile hospitals). Among the highest-quintile and lowest-quintile PerCI hospitals, incidence of early specialty palliative care consultation was 5.3% and 5.8%, respectively. Hospital-level use of early specialty palliative care consultation was not correlated with hospital-level probability of PerCI (P = .17).

Interpretation

In this study, cross-hospital differences in PerCI development were not explained by differential use of early specialty palliative care consultation. These findings suggests that hospital-level differences in PerCI development are explained by other care factors. Future research is needed to identify care processes that differentiate high-performing hospitals.

SUBMITTER: Viglianti EM 

PROVIDER: S-EPMC12801079 | biostudies-literature | 2025 Dec

REPOSITORIES: biostudies-literature