Inpatient outcomes and racial disparities of palliative care consults in mechanically ventilated patients in the United States

Abstract

Intensive care units (ICUs) account for a disproportionately large share of healthcare utilization. Our study examined the association between palliative care consults (PCC) and hospital outcomes in mechanically ventilated patients. We analyzed patients admitted from 2016 to 2019 using the National Inpatient Sample database. The primary outcome was the association of PCC and length of stay; secondary outcomes included the impact of PCC on total hospital costs. Of the 2,351,503 patients included, 15.5% had a PCC, with a male predominance (53%, P < 0.001). Whites had a higher PCC rate, at 167 per 1000 ICU cases, vs. Blacks, at 25 per 1000 cases (P < 0.001). Adjusted length of stay was 2.0 days less in patients with PCC (P < 0.001), and adjusted inpatient hospital cost was $12,942 lower in patients with PCC (P < 0.001). Whites had a larger decrease in length of stay and costs compared to blacks, Hispanics, and Asians (P < 0.001). In conclusion, PCC was associated with a shorter length of stay and lower inpatient hospital costs in critically ill ICU patients. Black patients saw a lower impact of PCC on LOS and hospital costs, as well as a lower rate of PCC.

Keywords:

• Critically ill patients
• end-of-life care
• intensive care unit
• palliative care