SHM Converge Scientific Abstract ePoster Gallery-Factors Associated With Advanced Care Directives and Palliative Care

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This retrospective study examined National Inpatient Sample hospitalizations from 2016–2019 to identify factors associated with do-not-resuscitate (DNR) orders and palliative care (PC), and to assess related outcomes. The analysis included more than 23.4 million records for patients with diagnoses such as Alzheimer’s disease, COPD, CHF, stroke, cancers, ESRD, Parkinson’s disease, and sepsis. Outcomes were adjusted for comorbidity burden using the Charlson index.<br /><br />Overall, most patients had neither DNR nor PC (92%). DNR only accounted for 5%, PC only for 1%, and both DNR and PC for 2%. Over time, both DNR and PC increased: PC rose from 2.55% to 3.27% and DNR from 6.31% to 7.7%, both statistically significant. These trends were generally consistent across age groups and races, although PC did not increase in some groups as much as DNR did.<br /><br />Demographic differences were notable. Compared with White patients, Black patients were less likely to have DNR status but more likely to receive PC. Men were also less likely than women to have DNR status, but slightly more likely to receive PC.<br /><br />In terms of outcomes, inpatient mortality and length of stay declined from 2016 to 2019, while hospital charges increased. Black race and male sex were associated with higher mortality, longer hospital stays, and greater charges. Among hospitalized patients overall, DNR and PC status were associated with higher mortality and longer length of stay.<br /><br />The study concludes that DNR and palliative care use increased over time in the U.S., but important racial and sex disparities persist in end-of-life care decisions and outcomes.

Asset Subtitle

Jean-Sebastien Rachoin

Meta Tag

Author List Elizabeth Cerceo, Jean-Sebastien Rachoin, Krystal Hunter, Nicole Debski

Category Research

Concept Advance care planning

Concept Do Not Resuscitate Order

Concept Palliative Care

Concept Health Disparities

Concept Mortality

Distinguished Non-Finalist

Presenter Organization Cooper University Healthcare, Cooper Medical School of Rowan University

Presenting Author Jean-Sebastien Rachoin

Track Outcomes Research

Keywords

do-not-resuscitate

palliative care

retrospective study

National Inpatient Sample

end-of-life care

hospital mortality

length of stay

racial disparities

sex disparities

Charlson comorbidity index

Advance care planning

Do Not Resuscitate Order

Palliative Care

Health Disparities

Mortality