Appointment utilization as a trigger for palliative care introduction: A retrospective cohort study

Area of Science:

• Nephrology
• Palliative Care
• Health Services Research

Background:

• Chronic kidney disease (CKD) palliative care guidelines need better health status measures.
• Identifying high-risk CKD patients is crucial for timely palliative care integration.

Purpose of the Study:

• To identify high-risk patients using administrative data.
• To facilitate timely and uniform palliative care involvement for CKD patients.

Main Methods:

• Retrospective cohort study.
• Monitored 45,368 Veterans with CKD Stages 3-5 for up to 6 years.
• Categorized patients based on death, dialysis initiation, or avoidance of both outcomes.

Main Results:

• Patient appointment utilization predicted outcomes, categorizing individuals into low, medium, and high utilizers.
• Low utilization increased dialysis risk; medium utilization stabilized death risk and decreased dialysis risk.
• High appointment utilization (over 31 visits) helped high-risk patients avoid death and dialysis.

Conclusions:

• A novel palliative care introduction trigger based on appointment utilization is proposed.
• This trigger could standardize conservative treatment preparation and aid policy development.
• Significant appointment utilization demonstrates a clear benefit for high-risk CKD patients.