Deficits in the Palliative Care Process Measures in Patients with Advanced Pancreatic Cancer Undergoing Operative and Invasive Nonoperative Palliative Procedures
Given survival measured in months, metrics, such as 30-day mortality, are poorly suited to measure the quality of palliative procedures for patients with advanced cancer. Nationally endorsed process measures associated with high-quality PC include code-status clarification, goals-of-care discussions, palliative-care referral, and hospice assessment. The impact of the performance of these process measures on subsequent healthcare utilization is unknown.
Administrative data and manual review were used to identify hospital admissions with performance of palliative procedures for advanced pancreatic cancer at two tertiary care hospitals from 2011 to 2016. Natural language processing, a form of computer-assisted abstraction, identified process measures in associated free-text notes. Healthcare utilization was compared using a Cox proportional hazard model.
We identified 823 hospital admissions with performance of a palliative procedure. PC process measures were identified in 68% of admissions. Patients with documented process measures were older (66 vs. 63; p = 0.04) and had a longer length of stay (9 vs. 6 days; p < 0.001). In multivariate analysis, patients treated by surgeons were less likely to have PC process measures performed (odds ratio 0.19; 95% confidence interval 0.10–0.37). Performance of PC process measures was associated with decreased healthcare utilization in a Cox proportional hazard model.
PC process measures were not performed in almost one-third of hospital admissions for palliative procedures in patients with advanced pancreatic cancer. Performance of established high-quality process measures for seriously ill patients undergoing palliative procedures may help patients to avoid burdensome, high-intensity care at the end-of-life.
Dr. Udelsman was supported by the Society of University Surgeons-KARL STORZ Resident Award (2017–2018). Dr. Cooper is supported by the Paul B. Beeson Emerging Leaders Career Development Award in Aging (1K76AG054859-01) and the Cambia Foundation. Dr. Cooper also received funding during this time, but not for support of this project, from PCORI (1502-27462), National Cancer Institute (1R35CA197730-01), and the National Institute on Aging (95R01AG044518-02). Dr. Lindvall is supported by the National Palliative Care Research Center Junior Faculty Career Development Award 2016-2018 and the Palliative Care Research Cooperative Group Pilot Award 2016–2017.
EJL and BVU had access to all data in this study and take full responsibility for the integrity of the data and accuracy of the analyses. Study concept and design: EJL, BVU, CL, ZC. Acquisition of data: EJL, ZC, BVU. Analysis and interpretation of the data: All authors. Drafting of the manuscript: EJL, BVU. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: EJL, BVU.
The authors have no conflicts of interest to disclose.
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