Factors Associated with Hospital Admission in the Last Month of Life

Outcomes 1. Participants will be able to describe factors that are more likely associated with hospital admission at the end of life.2. Participants will be able to describe potential modifiable factors that may improve end of life care. Key Message In a tertiary health system, a quarter of primary care patients were admitted to the hospital in their last month of life. These findings are important to design and develop collaborative specialty, primary care, and palliative care programs to improve end-of-life care. Context Hospital rankings include 30-day mortality rate from admission. Health systems would like to identify factors associated with admission in the last 30 days of life. Objective To evaluate patient factors associated with hospital admission in the last month of life. Methods We conducted a retrospective cohort study that included patients with a primary care visit in the last year of life from a single tertiary health system (n=8,488). Patient demographics, date of death, diagnosis codes, health care utilization (intensive care unit, hospitalization, emergency room visits, and primary care visits), palliative care consultations, resuscitation status, and serious illness conversation documentation were extracted from the electronic health record in the last year of life. We used multivariable logistic regression to identify patient factors associated with hospital admission in the last 30 days of life. Results From January 2019 to September 2021, 2,202 (25.9%) patients in the cohort had a hospital admission in their last 30 days. Factors associated with increased hospital admission in the last month included: younger age (< 65 years old, adjusted OR 1.51, 95% CI 1.27 – 1.80, 66 - 75 years, adjusted OR 1.42, 95% CI 1.21 – 1.68, reference > 85 years old), non-White race (adjusted OR 1.28, 95% CI 1.14 – 1.44). Compared to those without, patients with metastatic cancer (2,606, 18.1%), liver disease (2,123, 14.8%), and heart failure (3,010, 35.5%) had the highest odds of admission in the last 30 days of life (adjusted OR 2.36 95% CI 2.05-2.72; 2.28, 95% CI 1.98 - 2.62; and 2.17 95% CI 1.93-2.45 respectively). Conclusions Patients with heart and liver disease and metastatic cancer were at highest risk of hospital admission at the end of life. Collaborative interventions across specialty services, primary care, and palliative care may improve the quality of care at the end of life. Keywords Scientific Research / Prognostication