Palliative care in a hospital setting rose 30 fold among multiple sclerosis (MS) patients in the U.S. from 2005 to 2014, and was associated with longer hospital stays and greater numbers of in-hospital deaths but also lower overall costs, according to a large data study.
Increased reliance on such care was particularly evident after 2010 and partly attributed to passage of the Affordable Care Act, the healthcare reform package signed into law in March of that year.
The research, “Ten-year trends of palliative care utilization associated with multiple sclerosis patients in the United States from 2005 to 2014,” was published in the Journal of Clinical Neuroscience.
Palliative care puts emphasis on the prevention and relief of suffering with the goal of improving the quality of life of patients, and their families, who are dealing with an incurable or life-threatening illness.
Increasing evidence links the early introduction of palliative care with better clinical and public health outcomes, including shorter lengths of time in a hospital, lower in-hospital death rates, and lower hospital charges. In the U.S., health policy for palliative care has been mainly focused on cancer patients. Data shows that cancer patients given palliative care early in their disease course live longer than those who are not, even with less aggressive end-of-life treatment, the study noted.
In addition to research findings, the efficiency of palliative is supported Medicare data that’s included in the Hospital Value-Based Purchasing (VBP) program, part of the Affordable Care Act, officially known as the Patient Protection and Affordable Care Act.
Researchers in the U.S. and the Republic of Korea decided to examine palliative care among MS patients. They obtained a population-based estimate of national 10-year care trends among hospitalized MS patients, using a federal database known as the National Inpatient Sample (NIS).The NIS is the largest publicly available all-payer inpatient database in the U.S., with data on more than 7 million hospital inpatient stays each year.
With data covering 2005 to 2014, they looked at patient and clinical characteristics associated with palliative care to determine how this care impacted hospital utilization and costs for people with MS.
A total of 228,444 MS patients (mean age 54.0; 73.3% women, and 77.7% white) were included in the final analysis. Most, about 60%, were between the ages of 30 and 59.
Researchers accounted for patients’ age, sex, race, annual median household income, primary insurer — Medicare, private insurance, Medicaid, or others — number of comorbidities, and disease severity. Systemic procedures such as blood transfusion and mechanical or non-invasive ventilation were analyzed, as were hospital characteristics including location and bed-size.
Results showed that palliative care use among MS patient rose by 30 times — from 0.2% to 6.1% — during the study period, particularly between 2010 (1.5%) and 2011 (4.5%). Palliative care was higher in older patients, in men, and in patients with Medicare and Medicaid coverage compared to those on private insurance. Patients receiving systemic procedures and those who died in the hospital were also more likely to be on palliative care.
The proportion of MS patients on palliative care who died in the hospital rose from 7.7% in 2005 to 58.8% in 2014, data showed.
A longer hospital stay was also associated with in-hospital palliative care (an average of 0.444 more days) — a finding in this study that differed from previous studies — but overall hospital charges declined ($2,261 lower on average).
“In conclusion, the temporal trends of palliative care use in MS inpatients gradually increased with an exponential increase between 2010 and 2011 during 2005–2014, which is mostly attributed to both the [Affordable Care Act] implementation and patients with higher risk of in-hospital death,” the researchers wrote.
These results “provide nationally representative data that will be useful for epidemiological research, health policy development, and clinical use,” they said.
Two study limitations were a lack of analysis of palliative care given in the home, and not distinguishing among MS patients by the type of their disease, the team noted.