Variation in hospice use among trauma centers may impact analysis of geriatric trauma outcomes : an analysis of 1,961,228 CMS hospitalizations from 2,317 facilities

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FAKHRY, Samir M. | SHEN, Yan | WYSE, Ransom J. | GARLAND, Jeneva M. | WATTS, Dorraine D.

Background: Defining discharges to hospice as “deaths” is vital for properly assessing trauma center outcomes. This is critical with older patients as a higher proportion are discharged to hospice. The goals of this study were to measure rates of hospice use, evaluate hospice discharge rates by Trauma Center Level, and identify variables affecting hospice use in geriatric trauma. Methods: Patients from the CMS-Inpatient Standard Analytical Files for 2017-19, age = 65, with =1 injury ICD-10 code, at hospitals with >50 trauma patients per year were selected. Total Deaths (TD) was defined as inpatient deaths (ID) + hospice discharges (HD). Dominance analysis identified the most important contributors to a model of hospice use. Results: 1.96 M hospitalizations from 2317 hospitals (Level I-10%, II-14%, III-18%, IV-7%, None-51%) were included. Level Is had significantly lower raw HD values compared to Level II and III (I: 0.030; II: 0.035; III: 0.035; P < .05), but not Level IV (0.032) or Non-Trauma centers (0.030), P > .05). Adjusted Level I HD rates were lower than all other facility types (Level I: 0.026; II: 0.031; III: 0.034; IV: 0.033; Non-trauma: 0.030, P < .05). HD as a proportion of TD varied by level and was lowest (0.38) at Level I Centers. Dominance analysis showed ‘proportion of patients with ISS > 15’ contributed most to explaining hospice utilization rates (3.2%) followed by ‘Trauma center level’ (2.3%), ‘proportion white’ (1.9%), ‘proportion female’ (1.5%), and ‘urban/rural setting’ (1.4%). Conclusions: In this near population-based geriatric trauma analysis, Level I centers had the lowest hospice discharge rate, but HD rates varied significantly by trauma level and should be included in mortality assessments of hospital outcomes. As the population ages, accurate assessment of geriatric trauma outcomes becomes more critical. Further studies are needed to evaluate the optimal utilization of hospice in end-of-life decision-making for geriatric trauma.

http://dx.doi.org/10.1097/TA.0000000000003883

Voir la revue «The Journal of trauma and acute care surgery»

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