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- Title
Characteristics Associated with In-Hospital Death among Commercially Insured Decedents with Cancer.
- Authors
Brooks, Gabriel A.; Stuver, Sherri O.; Zhang, Yichen; Gottsch, Stephanie; Fraile, Belen; McNiff, Kristen; Dodek, Anton; Jacobson, Joseph O.
- Abstract
Background: A majority of patients with poor-prognosis cancer express a preference for in-home death; however, in-hospital deaths are common. Objective: We sought to identify characteristics associated with in-hospital death. Design: Case series. Setting/Subjects: Commercially insured patients with cancer who died between July 2010 and December 2013 and who had at least two outpatient visits at a tertiary cancer center during the last six months of life. Measurements: Patient characteristics, healthcare utilization, and in-hospital death (primary outcome) were ascertained from institutional records and healthcare claims. Bivariate and multivariable analyses were used to evaluate the association of in-hospital death with patient characteristics and end-of-life outcome measures. Results: We identified 904 decedents, with a median age of 59 years at death. In-hospital death was observed in 254 patients (28%), including 110 (12%) who died in an intensive care unit. Hematologic malignancy was associated with a 2.57 times increased risk of in-hospital death (95% confidence interval [CI] 1.91-3.45, p < 0.001), and nonenrollment in hospice was associated with a 14.5 times increased risk of in-hospital death (95% CI 9.81-21.4, p < 0.001). Time from cancer diagnosis to death was also associated with in-hospital death ( p = 0.003), with the greatest risk among patients dying within six months of cancer diagnosis. All significant associations persisted in multivariable analyses that were adjusted for baseline characteristics. Conclusions: In-hospital deaths are common among commercially insured cancer patients. Patients with hematologic malignancy and patients who die without receiving hospice services have a substantially higher incidence of in-hospital death.
- Subjects
CLINICAL medicine; CONFIDENCE intervals; DIAGNOSIS; HOSPICE care; HOSPITAL care; HOSPITAL emergency services; HEALTH insurance; CASE studies; MULTIVARIATE analysis; POISSON distribution; PROBABILITY theory; TUMORS; KEY performance indicators (Management); RELATIVE medical risk; RETROSPECTIVE studies
- Publication
Journal of Palliative Medicine, 2017, Vol 20, Issue 1, p42
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2016.0231