Category: Palliative Care
Objective: To analyze the rate of palliative care consultations among hospitalized patients with Parkinson’s Disease (PD) using the National Inpatient Sample data from 2007 to 2014.
Background: Early involvement of palliative care has been proved to be a powerful tool in PD. In fact, there has been a nationwide trend towards recognizing the benefit of early palliative care for chronic diseases in multiple fields, including neurology. Although such consultation is still underused, little is known about racial and ethnic disparities in the use of palliative care services in PD, especially in the inpatient setting.
Method: We performed a retrospective cohort study using the National Inpatient Sample from 2007 to 2014 to identify admitted patients with Parkinson’s Disease. PD ICD code and palliative care referral was identified using ICD-9-CM code V66.7 (encounter for palliative care), which have been validated in previous studies. Additionally, we also analyzed the use of consultation services, controlling for differences in hospital, income, educational level and medical comorbidities, including Charlson comorbidity index.
Results: We identified a total of 397,963 hospitalizations from 2007 to 2014 for patients aged 40 years or older. Of these, 10,639 (2.67%) were referred to palliative care. The rate of consultation increased significantly from 0.85% in 2007 to 4.49% in 2014, p <0.0001. Hispanics (OR 0.91, CI 0.84-0.99, p<0.045) and African American (OR 0.91, CI 0.83-0.99, p<0.036) were less likely to receive palliative care consultation than whites even after adjustment for other potential confounders. Female patients were less likely to be referred to palliative care (OR 0.90, CI 0.87-0.94, P<0.001). Other factors strongly associated with a higher rate of palliative care referral included private insurance when compared to Medicare/Medicaid (OR 2.12, CI 1.98-2.26, p<0.001) and higher income (OR 1.40, CI 1.33-1.48, p<0.001).
Conclusion: There has been a significant increase in palliative care referrals among hospitalized patients with PD in the US. After controlling for confounders, racial and ethnic disparities were found. Women, patients covered by Medicare/Medicaid and with lower income were also less likely to be referred to palliative care use. Further investigation identifying reasons for this discrepancy should be identified in order to develop strategies for improving care of patients with PD.
To cite this abstract in AMA style:S. Jimsheleishvili, D. Di Luca, M. Feldman, J. Margolesky, D. Shpiner, C. Singer, C. Luca. Trends and Racial Disparities of Palliative Care Use among Hospitalized Patients with Parkinson’s Disease [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/trends-and-racial-disparities-of-palliative-care-use-among-hospitalized-patients-with-parkinsons-disease/. Accessed December 9, 2023.
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