C24 CRITICAL CARE: IMPROVING FAMILY ENGAGEMENT AND PALLIATIVE AND END OF LIFE CARE IN THE ICU: Variability In Intensive Care Unit Utilization At The End Of Life In Patients With A Diagnosis Of Cancer: A Large Multi-State Hospital Network Experience

Publication Title

Am J Respir Crit Care Med

Document Type

Conference Proceeding

Publication Date

5-23-2017

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Introduction: There has been increasing attention to the quality of care for cancer patients at the end of life. Medicare, the largest insurer in the last year of life, is considering a number of palliative care metrics for performance initiatives pay. The Cancer Clinical Leadership Council endorsed evaluating the “Proportion Admitted to the intensive care unit (ICU) in the last 30 days of life (NQF 0213)” as a palliative care metric for addressing end of life care for cancer patients. The aim of this study was to determine the variability in ICU utilization in cancer patients, and assess if hospital size and geographic location factored into the number of ICU admissions in the last month of life. An ICU utilization rate close to the nationally reported averages 18-30% was hypothesized. Methods: A retrospective multi-institutional review of 9827 patients between 1/2014-6/2016 with an active diagnosis of cancer who died within 30 days of ICU admission was performed. All institutions are part of Providence Health and Services (PHS), a large nonprofit health system comprised of 35 acute care hospitals in 5 states. Documentation of an active diagnosis of cancer was obtained from the problem list, final ICU admission date prior to death was obtained from admission logs; and compared with death data obtained from the EMR, linked to the Social Security Death Index. ICU admission rates were compared by PHS regions and hospital size (small:200 beds). Results: The ICU system wide average for admission of patients with a diagnosis of cancer at the end of life was 22%, but significant variability exists by geographic location (p

Clinical Institute

Cancer

Specialty

Critical Care Medicine

Specialty

Palliative Care

Specialty

Oncology

DOI

10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A5036

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