Related Experiment Video
Updated: Sep 14, 2025
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Institutional Variation in Specialty Palliative Care Consultation Among Patients With Persistent Critical Illness: A
Elizabeth M Viglianti1, Jennifer Cano2, Sarah Seelye2
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, HSR Center of Innovation, Ann Arbor, MI.
Background:
Development of persistent critical illness (PerCI) necessitating prolonged ICU stays varies across hospitals. Specialty palliative care consultation may mitigate PerCI development by influencing the transition to comfort-directed care when appropriate.
Research Question:
Do hospitals with the lowest rates of PerCI have higher use of specialty palliative care consultations during the first 3 days of admission to the ICU as compared with hospitals with the highest rates of PerCI?
Study Design And Methods:
This was a retrospective cohort of veterans admitted to Veterans Affairs (VA) ICUs from October 2015 through December 2021. PerCI was defined as an ICU length of stay of at least 11 days. We used multilevel logistic regression to assess cross-hospital variation in risk-adjusted and reliability-adjusted probabilities of PerCI developing. We subsequently classified hospitals into quintiles of adjusted probabilities of PerCI and assessed incidence and timing of new specialty palliative care consultations by quintile. In sensitivity analyses, we assessed correlations between hospital-level incidence of early specialty palliative care consultation and adjusted probability of PerCI developing.
Results:
Among 371,280 ICU hospitalizations at 104 VA hospitals, 5.4% of patients (n = 19,904 of 371,280) experienced PerCI and 4.8% underwent an early specialty palliative care consultation. In adjusted models, development of PerCI ranged from 1.4% (lowest-quintile hospitals) to 5.4% (highest-quintile hospitals). Among the highest-quintile and lowest-quintile PerCI hospitals, incidence of early specialty palliative care consultation was 5.3% and 5.8%, respectively. Hospital-level use of early specialty palliative care consultation was not correlated with hospital-level probability of PerCI (P = .17).
Interpretation:
In this study, cross-hospital differences in PerCI development were not explained by differential use of early specialty palliative care consultation. These findings suggests that hospital-level differences in PerCI development are explained by other care factors. Future research is needed to identify care processes that differentiate high-performing hospitals.
More Related Videos
10:38Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
06:46Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Related Concept Videos
01:25Continuing Care
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:30Ethical Dilemmas II
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...