Use and Predictors of End-of-Life Care Among HIV Patients in a Safety Net Health System

Ramona L. Rhodes, Fiza Nazir, Sonya Lopez, Lei Xuan, Ank E. Nijhawan, Nicole E. Alexander-Scott, Ethan A. Halm

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Pain and Symptom Management
DOIs
StateAccepted/In press - 2015

Fingerprint

Terminal Care
Hospices
HIV
Palliative Care
Safety
Health
Advance Directives
Safety-net Providers
Odds Ratio
Electronic Health Records
Highly Active Antiretroviral Therapy
International Classification of Diseases
African Americans
Albumins
Cohort Studies
Referral and Consultation
Retrospective Studies
Logistic Models
Physicians
Survival

Keywords

  • HIV
  • Hospice
  • Palliative care
  • Safety net

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Nursing(all)

Cite this

Use and Predictors of End-of-Life Care Among HIV Patients in a Safety Net Health System. / Rhodes, Ramona L.; Nazir, Fiza; Lopez, Sonya; Xuan, Lei; Nijhawan, Ank E.; Alexander-Scott, Nicole E.; Halm, Ethan A.

In: Journal of Pain and Symptom Management, 2015.

Research output: Contribution to journalArticle

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title = "Use and Predictors of End-of-Life Care Among HIV Patients in a Safety Net Health System",
abstract = "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.",
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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.

PY - 2015

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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.

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