Racial/Ethnic Differences in Acute Care Utilization, Costs, and Hospice Use Among Patients Who Receive Palliative Care Consultation to Discuss Goals of Care (SCI953)

Abstract

1.Describe acute care utilization (days hospitalized, ICU days) and costs of patients who received palliative care consultation to discuss goals-of-care (PCC) by race/ethnicity (White, African American, Hispanic, Asian, Other, Unknown race/ethnicity).2.Compare future acute care utilization (30-day readmissions, future hospital days, future intensive care unit [ICU] admission, future number of ICU days) and future costs by race/ethnicity among patients who received palliative care consultation to discuss goals-of-care (PCC).3.Compare hospice use and do-not-resuscitate status by race/ethnicity among patients who received palliative care consultation to discuss goals-of-care (PCC). Racial disparities in serious illness communication are associated with more intensive end-of-life care, higher costs, and lower quality of death among racial/ethnic minorities. Palliative care consultation to discuss care goals (PCC) may help mitigate racial disparities in end-of-life care, but little is known about how outcomes differ among PCC patients by race/ethnicity. To describe acute care utilization, costs, hospice use, do-not-resuscitate (DNR) status, and changes in care goals among patients who received PCC by race/ethnicity (White, African American, Hispanic, Asian, Other, Unknown). We conducted a secondary analysis of an observational study of 1390 patients who received PCC at an urban academic medical center July 2014 through October 2016. Participants were age 18+ admitted for conditions other than childbirth or rehabilitation, not hospitalized at the end of the study, and did not die during index hospitalization when consultation occurred. One-way ANOVA, Kruskal-Wallis, and Chi-squared tests were used to identify differences. Median acute care costs accrued during admission with PCC, future acute care utilization and costs, 30-day readmissions, and DNR status significantly differed by race/ethnicity among PCC patients. African American and Hispanic PCC patients had the highest 30-day readmission rates and rates of future acute care use. Discharge to hospice, future ICU use, and whether a patient changed care goals did not differ by race/ethnicity among PCC patients. Future acute care utilization, costs, and DNR documentation differed by race/ethnicity. However, hospice use following palliative care consultation did not differ by race/ethnicity, suggesting care goal consultations may help mitigate racial disparities in end-of-life care.