ArticleCritical care medicine2019
Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs.
Article in Critical care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review.Intensive care medicine · 2024Pooled it
- Clinical outcomes of a joint ICU and palliative care multidisciplinary rounding model: A retrospective cohort study.PloS one · 2024Article
- Application of Instrumental Variable Analysis in Pediatric End-of-Life Research: A Case Study.Western journal of nursing research · 2023Article
- Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019.Critical care (London, England) · 2022Observational
- Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members.JAMA network open · 2022Article
- Levosimendan increases brain tissue oxygen levels after cardiopulmonary resuscitation independent of cardiac function and cerebral perfusion.Scientific reports · 2021Article
- Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives.Journal of multidisciplinary healthcare · 2021Review
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Authors and funding
8 authors.
Funding
Abstract
objectivesAs ICUs are increasingly a site of end-of-life care, many have adopted end-of-life care resources. We sought to determine the association of such resources with outcomes of ICU patients.
designRetrospective cohort study.
settingPennsylvania ICUs. PATIENTS: Medicare fee-for-service beneficiaries.
interventionsAvailability of any of one hospital-based resource (palliative care consultants) or four ICU-based resources (protocol for withdrawal of life-sustaining therapy, triggers for automated palliative care consultation, protocol for family meetings, and palliative care clinicians embedded in ICU rounds). MEASUREMENTS AND MAIN
resultsIn mixed-effects regression analyses, admission to a hospital with end-of-life resources was not associated with mortality, length of stay, or treatment intensity (mechanical ventilation, hemodialysis, tracheostomy, gastrostomy, artificial nutrition, or cardiopulmonary resuscitation); however, it was associated with a higher likelihood of discharge to hospice (odds ratio, 1.58; 95% CI, 1.11-2.24), an effect that was driven by ICU-based resources (odds ratio, 1.37; 95% CI, 1.04-1.81) rather than hospital-based resources (odds ratio, 1.19; 95% CI, 0.83-1.71). Instrumental variable analysis using differential distance (defined as the additional travel distance beyond the hospital closest to a patient's home needed to reach a hospital with end-of-life resources) demonstrated that among those for whom differential distance would influence receipt of end-of-life resources, admission to a hospital with such resources was not associated with any outcome.
conclusionsICU-based end-of-life care resources do not appear to change mortality but are associated with increased hospice utilization. Given that this finding was not confirmed by the instrumental variable analysis, future studies should attempt to verify this finding, and identify specific resources or processes of care that impact the care of ICU patients at the end of life.
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