Factors Associated with Hospital Admission in the Last Month of Life (RP313)

Outcomes 1. Describe factors that are more likely associated with hospital admission at the end of life.2. Describe potential collaborative interventions 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. Importance 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(s) To evaluate patient factors associated with hospital admission in the last month of life. Scientific Methods Utilized 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 these comorbidities, 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). Conclusion(s) Patients with heart and liver disease and metastatic cancer were at the highest risk of hospital admission at the end of life. Impact Collaborative interventions across specialty services, primary care, and palliative care may improve the quality of care at the end of life. Keywords Models of palliative/hospice care delivery/Palliative care in chronic, non-malignant illness