Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness

Kyle Lavin, Dimitry S. Davydow, Lois Downey, Ruth A. Engelberg, Ben Dunlap, James Sibley, William B. Lober, Kelson Okimoto, Nita Khandelwal, Elizabeth T. Loggers, Joan Teno, J. Randall Curtis

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Context Little is known about psychiatric illness and utilization of end-of-life care. Objectives We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. Methods We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases–9 codes. We used International Classification of Diseases–9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. Results Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. Conclusion Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care.

Original languageEnglish (US)
Pages (from-to)176-185.e1
JournalJournal of Pain and Symptom Management
Volume54
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Psychiatry
Preexisting Condition Coverage
Terminal Care
Electronic Health Records
Nursing Homes
Prescriptions
Intensive Care Units
Hospital Emergency Service
Inpatients
Hospitalization
Chronic Disease

Keywords

  • end-of-life care
  • epidemiology
  • multimorbidity
  • Palliative care
  • psychiatric illness

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Lavin, K., Davydow, D. S., Downey, L., Engelberg, R. A., Dunlap, B., Sibley, J., ... Curtis, J. R. (2017). Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness. Journal of Pain and Symptom Management, 54(2), 176-185.e1. https://doi.org/10.1016/j.jpainsymman.2017.04.003

Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness. / Lavin, Kyle; Davydow, Dimitry S.; Downey, Lois; Engelberg, Ruth A.; Dunlap, Ben; Sibley, James; Lober, William B.; Okimoto, Kelson; Khandelwal, Nita; Loggers, Elizabeth T.; Teno, Joan; Curtis, J. Randall.

In: Journal of Pain and Symptom Management, Vol. 54, No. 2, 01.08.2017, p. 176-185.e1.

Research output: Contribution to journalArticle

Lavin, K, Davydow, DS, Downey, L, Engelberg, RA, Dunlap, B, Sibley, J, Lober, WB, Okimoto, K, Khandelwal, N, Loggers, ET, Teno, J & Curtis, JR 2017, 'Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness', Journal of Pain and Symptom Management, vol. 54, no. 2, pp. 176-185.e1. https://doi.org/10.1016/j.jpainsymman.2017.04.003
Lavin, Kyle ; Davydow, Dimitry S. ; Downey, Lois ; Engelberg, Ruth A. ; Dunlap, Ben ; Sibley, James ; Lober, William B. ; Okimoto, Kelson ; Khandelwal, Nita ; Loggers, Elizabeth T. ; Teno, Joan ; Curtis, J. Randall. / Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness. In: Journal of Pain and Symptom Management. 2017 ; Vol. 54, No. 2. pp. 176-185.e1.
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abstract = "Context Little is known about psychiatric illness and utilization of end-of-life care. Objectives We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. Methods We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases–9 codes. We used International Classification of Diseases–9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. Results Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. Conclusion Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care.",
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