Access to Palliative Care Consultation for Hospitalized Adults with COVID-19 in an Urban Health System: Were There Disparities at the Peak of the Pandemic?
Access to Palliative Care Consultation for Hospitalized Adults with COVID-19 in an Urban Health System: Were There Disparities at the Peak of the Pandemic?
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DOI：
10.1089/jpm.2021.0313
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发表时间：
2021-10-08
影响因子：
2.8
通讯作者：
Gelfman, Laura P.
中科院分区：
文献类型：
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作者：
Frydman, Julia L.;Aldridge, Melissa;Gelfman, Laura P.
背景：姑息治疗 (PC) 服务迅速扩大，以满足 2019 年冠状病毒病 (COVID-19) 患者的需求，但人们对哪些患者在大流行期间被转诊接受 PC 会诊知之甚少。目的：检查预测 COVID-19 患者 PC 会诊的因素。设计：对从四家医院出院的 COVID-19 患者（2020 年 3 月 1 日至 6 月 30 日）进行回顾性队列研究。暴露：患者人口统计学、社会经济和临床因素以及医院层面的特征。结果测量：住院 PC 会诊。结果：在 4319 名住院的 COVID-19 患者中，581 名 (14%) 接受了 PC 会诊。年龄增长、严重疾病（癌症、慢性阻塞性肺疾病和痴呆）、病情严重程度以及入住四级医院与接受PC会诊有关。 PC 咨询与种族/族裔、家庭拥挤、保险状况或医院因素（包括住院病人、急诊室和重症监护病房人口普查）之间没有关联。结论：尽管存在地点差异，但最敏锐度最高的患者最有可能接受 PC 咨询，而不会存在种族/民族或社会经济差异。
Background: Palliative care (PC) services expanded rapidly to meet the needs of coronavirus disease 2019 (COVID-19) patients, yet little is known about which patients were referred for PC consultation during the pandemic.Objective: Examine factors predictive of PC consultation for COVID-19 patients.Design: Retrospective cohort study of COVID-19 patients discharged from four hospitals (March 1-June 30, 2020).Exposures: Patient demographic, socioeconomic, and clinical factors and hospital-level characteristics.Outcome Measurement: Inpatient PC consultation.Results: Of 4319 hospitalized COVID-19 patients, 581 (14%) received PC consultation. Increasing age, serious illness (cancer, chronic obstructive pulmonary disease, and dementia), greater illness severity, and admission to the quaternary hospital were associated with receipt of PC consultation. There was no association between PC consultation and race/ethnicity, household crowding, insurance status, or hospital-factors, including inpatient, emergency department, and intensive care unit census.Conclusions: Although site variation existed, the highest acuity patients were most likely to receive PC consultation without racial/ethnic or socioeconomic disparities.