Increased hospice enrollment and decreased neurosurgical interventions without changes in mortality for older Medicare patients with moderate to severe traumatic brain injury - 13/06/18
, Elizabeth J. Lilley b, c , Stephanie Nitzschke a , Adil H. Haider a, b , Ali Salim a, b , Zara Cooper a, b, ⁎ Abstract |
Background |
Hospice improves quality and value of end of life care (EOLC), and enrollment has increased for older patients dying from chronic medical conditions. It remains unknown if the same is true for older patients who die after moderate to severe traumatic brain injury (msTBI).
Methods |
Subjects included Medicare beneficiaries (≥65 years) who were hospitalized for msTBI from 2005 to 2011. Outcomes included intensity and quality of EOLC for decedents within 30 days of admission, and 30-day mortality for the entire cohort. Logistic regression was used to analyze the association between year of admission, mortality, and EOLC.
Results |
Among 50,342 older adults, 30-day mortality was 61.2%. Mortality was unchanged over the study period (aOR 0.93 [0.87–1.00], p = 0.06). Additionally, 30-day non-survivors had greater odds of hospice enrollment, lower odds of undergoing neurosurgery, but greater odds of gastrostomy.
Conclusion |
Between 2005 and 2011, hospice enrollment increased, but there was no change in 30-day mortality.
El texto completo de este artículo está disponible en PDF.Highlights |
• | Hospice improves quality and value of end of life care (EOLC), but it remains unknown if the same is true for older patients who die after moderate to severe traumatic brain injury (msTBI). |
• | Logistic regression was used to analyze the association between year of admission, mortality, and EOLC for Medicare beneficiaries hospitalized for msTBI between 2005-2011. |
• | Over the study period, there was a decrease in neurosurgical procedures and a concomitant increase in hospice enrollment and gastrostomy tube placements, and no change in 30-day mortality among older patients with msTBI. |
Keywords : Trauma, End-of-life, Geriatric, Traumatic brain injury, Medicare
Esquema
Vol 215 - N° 6
P. 1016-1019 - juin 2018 Regresar al número
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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