TY - JOUR
T1 - Use and predictors of end-of-life care among HIV patients in a safety net health system
AU - Rhodes, Ramona L.
AU - Nazir, Fiza
AU - Lopez, Sonya
AU - Xuan, Lei
AU - Nijhawan, Ank E.
AU - Alexander-Scott, Nicole E.
AU - Halm, Ethan A.
N1 - Funding Information:
This work was conducted with support from UT-STAR , NIH / NCATS grant number KL2TR000453 , and AHRQ grant 1R24HS022418 . The content is solely the responsibility of the authors and does not necessarily represent the official views of UT-STAR, UT Southwestern Medical Center and its affiliated academic and health-care centers, the National Center for Advancing Translational Sciences, the National Institutes of Health, or the Agency for Healthcare Research and Quality. The authors declare no conflicts of interest.
Publisher Copyright:
© 2016 American Academy of Hospice and Palliative Medicine.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Context Although highly active antiretroviral therapy has improved survival among many HIV patients, there are still those with advanced illness and limited access to care who may benefit from palliative care and hospice. Objectives To examine completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital. Methods This was a retrospective cohort study of HIV patients in a large, urban safety net hospital in 2010. Physicians abstracted data from the electronic medical record on patient and clinical factors and end-of-life care use. Logistic regression examined predictors of hospice use. Results Overall, 367 HIV patients identified electronically by International Classification of Disease (ICD)-9 code were hospitalized in 2010. The mean age was 42 years, and 57% were African American. Although 28% died, only 6% of the sample received palliative care consultation, and 6% of the sample enrolled in hospice. Those who received hospice had lower albumin levels (adjusted odds ratio [AOR] 4.53, 95% CI 1.19-17.34) had received palliative care (AOR 9.73, 95% CI 2.10-45.09) and completed an advance directive (AOR 16.33, 95% CI 4.23-61.68). Of those patients who received hospice, the mean time to death after enrollment was 11 days. Conclusion Among an urban cohort of HIV patients, the rates of advance directive completion, palliative care use, and hospice use were low. Despite advancements in the treatment of HIV, many patients with advanced illness may benefit from palliative care and hospice services. Advances should be made in identifying those patients earlier in their disease trajectories.
AB - Context Although highly active antiretroviral therapy has improved survival among many HIV patients, there are still those with advanced illness and limited access to care who may benefit from palliative care and hospice. Objectives To examine completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital. Methods This was a retrospective cohort study of HIV patients in a large, urban safety net hospital in 2010. Physicians abstracted data from the electronic medical record on patient and clinical factors and end-of-life care use. Logistic regression examined predictors of hospice use. Results Overall, 367 HIV patients identified electronically by International Classification of Disease (ICD)-9 code were hospitalized in 2010. The mean age was 42 years, and 57% were African American. Although 28% died, only 6% of the sample received palliative care consultation, and 6% of the sample enrolled in hospice. Those who received hospice had lower albumin levels (adjusted odds ratio [AOR] 4.53, 95% CI 1.19-17.34) had received palliative care (AOR 9.73, 95% CI 2.10-45.09) and completed an advance directive (AOR 16.33, 95% CI 4.23-61.68). Of those patients who received hospice, the mean time to death after enrollment was 11 days. Conclusion Among an urban cohort of HIV patients, the rates of advance directive completion, palliative care use, and hospice use were low. Despite advancements in the treatment of HIV, many patients with advanced illness may benefit from palliative care and hospice services. Advances should be made in identifying those patients earlier in their disease trajectories.
KW - HIV
KW - Hospice
KW - palliative care
KW - safety net
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U2 - 10.1016/j.jpainsymman.2015.08.010
DO - 10.1016/j.jpainsymman.2015.08.010
M3 - Article
C2 - 26384554
AN - SCOPUS:84955654203
VL - 51
SP - 120
EP - 125
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
SN - 0885-3924
IS - 1
ER -