S1062 Predictors and Outcomes of Palliative Care Consultations for Cirrhotics: Results of a Cohort Study of 75 Million Medical Records

Abstract

INTRODUCTION: Approximately 600,000 adults in the United States (US) have liver cirrhosis. The total annual cost of hospitalizations due to cirrhosis is estimated to be about $7 billion. Liver transplantation is the only effective cure for decompensated cirrhosis, however, annually only about 8,000 liver transplants are performed in the US. Palliative care consultation can decrease health care utilizations and improve quality of life for patients and their caregivers. We aim to study the utilization of palliative care consultations and their impact on patient care across the US by conducting a large population-based cohort study. METHODS: The Explorys database (IBM, New York) is a source of de-identified data collected from electronic medical records from over 26 health systems in the United States amounting to over 75 million unique electronic medical records (EMR). All data including demographics, observations, diagnosis and procedures are coded by the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) criteria. We queried the database for a diagnosis of ‘cirrhosis’ followed by ‘palliative care consultation’ in a temporal manner and collected demographic and clinical data from 1999-2020. Odds ratio (OR) with 95% confidence intervals (CI) were calculated, with P < 0.05 considered significant. RESULTS: The Explorys database contained over 75 million patients at the time of our search. We identified 316,970 patients with cirrhosis and 0.76% (n = 2,400) patients with subsequent orthotopic liver transplant. Palliative care was consulted for 10.9% (n = 34,600) of patients. Patients who underwent a liver transplant were less likely to receive palliative care [OR 0.05 (0.05–0.067), P < 0.0001]. Patients aged >65 [OR 1.33 (1.30–1.36), P < 0.0001], male gender [OR 1.13 (1.11–1.16), P < 0.0001], a diagnosis of hepatocellular carcinoma (HCC) [OR 2.53 (2.45–2.60), P < 0.0001] and Medicare insurance [OR 4.2 (4.1–4.3), P < 0.0001] were more likely to receive a palliative care consultation. Patients for whom palliative care were consulted were less likely to undergo endoscopic [OR 0.32 (0.31–0.33)] and surgical procedures [OR 0.49 (0.47–0.50)]. CONCLUSION: Only about 1 in 10 cirrhotics received a palliative care consultation. Older patients, males, and patients with a diagnosis of HCC are more likely to receive palliative care. There is a need to address the under-utilization of palliative care consultations in cirrhotics to improve quality of life and decrease hospital resource utilization.Table 1.: Comparison of characteristics of cirrhotics with and without palliative care consultationsFigure 1.: Distribution of palliative care consultations amongst cirrhotics based on liver transplantation status.