Palliative care impact on hospital utilization and trends among lung cancer admissions with a high risk of mortality in US hospitals

초록

Background: The top 5% of healthcare utilization accounts for 60% of healthcare expenditure in the U.S., with the majority of the costs occurring in the last year of life for hospital inpatient services for diseases such as lung cancer (LC). Previous years' concentrated healthcare expenditure burdens have been shared globally. The research questions of this study are whether palliative care (PC) is associated with hospital utilization and what the PC trends are in U.S. hospitals. Thus, this study aimed to examine (1) the impact of hospital PC on hospital utilization charges and length of stay (LOS), and (2) PC trends, particularly before and after 2016 when a tri-convergent shift occurred in federal reimbursement, professional clinical guideline establishment, and legislative policy. Methods: This was a retrospective study that analyzed the National Inpatient Sample between 2002 and 2021. Adults 18+ years with LC and high-risk mortality were identified as the denominator. PC utilization was the main outcome measurement and the numerator. Hospital LOS (in days) and charges were secondary outcome measurements. An interrupted time series analysis was applied in 2016 as a U.S. healthcare breakpoint. Results: A total of 11,185,408 admissions were identified. PC utilization increased from 2.38% in 2002-2006 to 7.74% in 2007-2011, 13.29% in 2012-2016, and 15.86% in 2017-2021 (p < 0.001). The upward trend in PC utilization has decelerated by 6.40% (t = -9.67, p < 0.001) since 2016. PC was associated with a 1.22-day shorter LOS (t = -48.2, p < 0.001) and hospital charges that were $13,208.85 lower (t = -39.95, p < 0.001). Conclusion: PC utilization increased but slowed from 2016, with underuse persisting (<20% in 2021) among LC admissions in U.S. hospitals. PC utilization improves efficiency among patients with LC and a high risk of mortality by reducing hospital LOS and charges by 15%, respectively.

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