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Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis

Published online by Cambridge University Press:  15 February 2017

Xibei Liu ,
Yaser Dawod ,
Alex Wonnaparhown ,
Amaan Shafi ,
Loomee Doo ,
Ji Won Yoo ,
Eunjeong Ko  and
Youn Seon Choi
Xibei Liu
Affiliation:
University of Nevada, Reno School of Medicine, Reno, Nevada
Yaser Dawod
Affiliation:
Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, Nevada
Alex Wonnaparhown
Affiliation:
University of Nevada, Reno School of Medicine, Reno, Nevada
Amaan Shafi
Affiliation:
University of Nevada, Reno School of Medicine, Reno, Nevada
Loomee Doo
Affiliation:
Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, Nevada
Ji Won Yoo*
Affiliation:
Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, Nevada
Eunjeong Ko
Affiliation:
School of Social Work, San Diego State University, San Diego, California
Youn Seon Choi
Affiliation:
Department of Family Medicine, Guro Hospital, Korea University, Seoul, Korea
*
Address correspondence and reprint requests to: Ji Won Yoo, Department of Internal Medicine, University of Nevada School of Medicine, 1701 West Charleston Boulevard, #230, Las Vegas, Nevada 89102. E-mail: [email protected].
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Abstract

Objective:

Hospital palliative care has been shown to improve quality of life and optimize hospital utilization for seriously ill patients who need intensive care. The present review examined whether hospital palliative care in intensive care (ICU) and non-ICU settings will influence hospital length of stay and in-hospital mortality.

Method:

A systematic search of CINAHL/EBSCO, the Cochrane Library, Google Scholar, MEDLINE/Ovid, PubMed, and the Web of Science through 12 October 2016 identified 16 studies that examined the effects of hospital palliative care and reported on hospital length of stay and in-hospital death. Random-effects pooled odds ratios and mean differences with corresponding 95% confidence intervals were estimated. Heterogeneity was measured by the I2 test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to assess the overall quality of the evidence.

Results:

Of the reviewed 932 articles found in our search, we reviewed the full text of 76 eligible articles and excluded 60 of those, which resulted in a final total of 16 studies for analysis. Five studies were duplicated with regard to outcomes. A total of 18,330 and 9,452 patients were analyzed for hospital length of stay and in-hospital mortality from 11 and 10 studies, respectively. Hospital palliative care increased mean hospital length of stay by 0.19 days (pooled mean difference = 0.19; 95% confidence interval [CI95%] = –2.22–2.61 days; p = 0.87; I2 = 95.88%) and reduced in-hospital mortality by 34% (pooled odds ratio = 0.66; CI95% = 0.52–0.84; p < 0.01; I2 = 48.82%). The overall quality of evidence for both hospital length of stay and in-hospital mortality was rated as very low and low, respectively.

Significance of results:

Hospital palliative care was associated with a 34% reduction of in-hospital mortality but had no correlation with hospital length of stay.

Keywords

End-of-life careIn-hospital mortalityLength of stayPalliative care
Type
Review Article
Information
Palliative & Supportive Care , Volume 15 , Issue 6 , December 2017 , pp. 741 - 752
Copyright
Copyright © Cambridge University Press 2017 

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