Abstract
BACKGROUND: We investigated the trends and hospital outcome measures associated with the utilization of consultative palliative care (PC) services among patients with nontraumatic intracerebral hemorrhage (ICH). METHODS: This was a retrospective observational cohort study using the National Inpatient Sample (2002-2022) of patients admitted with ICH. Variables recorded included the rate of PC, age, gender, race, income, insurance type, hospital location and region, comorbidities, ICH severity indicators (coma, cerebral edema, brain compression, hydrocephalus, neurosurgical procedures), and in-hospital outcomes (mortality, cost, disposition). Temporal trends were assessed using linear logistic models for each patient-level variable. The cohort was divided in PC and non-PC (nPC) groups. Propensity-score matching (PSM) was applied to balance comorbidities and severity between the two groups. Binary logistic regression was used to analyze in-hospital outcomes. P value was set at 0.01. RESULTS: Of 452,250 ICH cases during the study period, 69,360 (15.3 %) received PC. Compared to nPC, ICH patients receiving PC were older [IQR] (75 [63-84] vs. 68 [56-79] years), more frequently women (52.4 % vs. 48.1 %), White (67.7 % vs. 56.2.%), and more likely to be in the highest income quartile (23.2 % vs. 22.6 %), p < 0.01 for all. Temporal analysis showed a significant increase in PC utilization from 1.7 % in 2002 to 23.5 % in 2022 (β = 0.013, 95 % CI: 0.011-0.014), with the steepest increase after 2007. Within subgroups, there was statistically greater increases of the use of PC among White patients (β = 0.014, 95 % CI: 0.012-0.016, p < 0.01), Medicare payers (β = 0.015, 95 % CI: 0.013-0.017, p < 0.01) and age ≥ 80 years (β = 0.02, 95 % CI: 0.018-0.022, p < 0.01) throughout the study period. There were trends toward higher increase in PC utilization in women and in Midwest among U.S. region, without reaching statistical significance. After 1:1 PSM, PC utilization remained independently associated with shorter length of stay (OR: 0.619, 95 %CI: 0.604-0.635), lower hospitalization cost (OR: 0.853, 95 %CI: 0.832 - 0.874), and higher odds of discharge to hospice/in-hospital mortality (RR: 4.444, 95 %CI: 4.342-4.549), p < 0.01 for all. CONCLUSIONS: The use of PC in ICH patients has increased over the past two decades. PC is associated with more efficient healthcare resource utilization and higher odds of discharge to hospice/in-hospital mortality. Disparities in PC utilization persist among underprivileged groups and racial minorities.