Latent Class Analysis of Specialized Palliative Care Needs in Adult Intensive Care Units From a Single Academic Medical Center.
Context: In the intensive care unit (ICU), 14% of patients meet criteria for specialized palliative care, but whether subgroups of patients differ in their palliative care needs is unknown.Objectives: The objective of this study was to use latent class analysis to separate ICU patients into differen...
| Published in: | Journal of Pain & Symptom Management Vol. 57; no. 1; pp. 73 - 79 |
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| Main Authors: | , , , |
| Format: | research Journal Article |
| Published: |
Elsevier B.V.
Jan2019
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=133787206&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 133787206 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 08853924 4CB jtl: Journal of Pain & Symptom Management issn: 08853924 maglogo: N pubinfo: dt: Jan2019 vid: 57 iid: 1 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 133787206 133787206 NLM30315914 133787206 10.1016/j.jpainsymman.2018.10.270 NLM30315914 133787206 ppf: 73 ppct: 6 formats: tig: atl: Latent Class Analysis of Specialized Palliative Care Needs in Adult Intensive Care Units From a Single Academic Medical Center. aug: au: Wang, David Ing, Caleb Blinderman, Craig D. Hua, May affil: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, USA sug: subj: Intensive Care Units Palliative Care Classification Advance Directives Critical Care Female Academic Medical Centers Male Retrospective Design Adult Pain Therapy Aged Referral and Consultation Human Validation Studies Comparative Studies Evaluation Research Multicenter Studies Adult: 19-44 years Aged: 65+ years Female Male ab: Context: In the intensive care unit (ICU), 14% of patients meet criteria for specialized palliative care, but whether subgroups of patients differ in their palliative care needs is unknown.Objectives: The objective of this study was to use latent class analysis to separate ICU patients into different classes of palliative care needs and determine if such classes differ in their palliative care resource requirements.Methods: We conducted a retrospective cohort study of ICU patients who received specialized palliative care, August 2013 to August 2015. Reason(s) for consultation were extracted from the initial note and entered into a latent class analysis model to generate mutually exclusive patient classes. Differences in "high use" of palliative care (defined as having five or more palliative care visits) between classes were assessed using logistic regression, adjusting for age, race, Charlson Comorbidity Index, and length of stay.Results: In a sample of 689 patients, a four-class model provided the most meaningful groupings: 1) Pain and Symptom Management (n = 218, 31.6%), 2) Goals of Care and Advance Directives (GCAD) (n = 131, 19.0%), 3) All Needs (n = 112, 16.3%), and 4) Supportive Care (n = 228, 33.1%). In comparison to GCAD patients, all other classes were more likely to require "high use" of palliative care (adjusted odds ratio [aOR] 2.61 [1.41-4.83] for "All Needs," aOR 2.01 [1.16-3.50] for "Pain and Symptom Management," aOR 1.94 [1.12-3.34] for "Supportive Care").Conclusion: Based on the initial reason for consultation, we identified four classes of palliative care needs among critically ill patients, and GCAD patients were least likely to be high utilizers. These findings may help inform allocation of palliative care resources for this population. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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