Abstract WP364: Utilization of End-of-Life Care Services in Stroke Patients Across a Large Health System

Abstract

Background: Patients presenting to hospitals with devastating strokes have high mortality rates (a national quality metric) and significant needs for end-of-life (EOL) care including palliative care (PC) and hospice services. Appropriate utilization of PC/hospice services across a health system can improve timeliness of care delivery and inpatient mortality rates. Our hospital system consists of 11 hospitals; 1 tertiary academic center (TAC)/comprehensive stroke center (CSC) and 10 community hospitals of which 3 are CSCs and 5 are primary stroke centers. In-house hospice is based in a community CSC and not the TAC. We investigated mortality, early death, and PC/hospice utilization to understand whether EOL services are effectively used across our system. Methods: Stroke patients (by DRG) and EOL utilization (defined by PC/hospice ICD 10 codes or MD specialty) were identified from January-December 2018. The TAC data were compared to the combined data of the other 10 system hospitals. Outcomes include EOL utilization, PC/Hospice utilization rates, and early deaths (deaths within 48 hours of admission). Chi-square was used to analyze categorical variables. Significance level was set at p<0.05. Analyses were performed using SAS 9.4 Results: Total stroke volume was 4,062: 1228 presented to the TAC and 2,834 to the 10 other system hospitals. The TAC and system mortality is 12% and 6% respectively. The EOL utilization rate at the TAC (19%) is significantly higher (p<0.0001) than across the system (8%). PC utilization (TAC 18% vs system 6%, p<0.0001) and hospice utilization (TAC 7% vs system 4%, p=0.0009) are significantly higher at the TAC. At the EOL, the TAC (37%) had significantly fewer (p=0.0004) patients with hospice involvement compared to the system (53%). Early deaths occurred significantly more (p<0.0001) at the TAC (7%) than across the system (2%). Conclusions: Stroke mortality and EOL needs are concentrated at our TAC while hospice care is based at and more utilized in the community hospitals. Our data supports implementing a hospice service at the TAC to enhance PC delivery for high mortality stroke volume and developing an EOL Stroke Pathway to standardize care delivery.