Trends in Palliative Care Utilization in Patients With Multiple Sclerosis

Background

Multiple sclerosis (MS) is a neurological disorder that affects an estimated 400,000 people in the United States. MS is not a lethal disease; however, the life span of patients with MS is usually 5 to 10 years shorter when compared with the life span of patients who do not have MS. Common conditions and comorbidities among patients with MS include the inability to ambulate independently, falls, bladder dysfunction, bowel dysfunction, infections, cardiovascular disease, respiratory disease, depression, and cognitive disorders. Large healthcare expenditures are incurred when MS-related comorbidities are treated.¹

Evidence has supported the use of palliative care in populations with incurable or life-threatening conditions. Palliative care decreases suffering by means of early intervention aimed at treating physical, psychological, and spiritual sufferings and has also been shown to decrease healthcare expenditures (eg, hospital length of stay, inpatient deaths, and hospital charges) in patients with cancer and many other non—cancer-related chronic diseases (eg, heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or certain neurodegenerative conditions). The hospital Value-Based Purchasing program under the Patient Protection and Affordable Care Act has promoted the use of palliative care in the US hospital setting. According to the authors, at the time this study was conducted, there were no previous reports of trends in utilization of palliative care among patients with MS.¹

Methods

Results

This study evaluated 10-year trends of palliative care utilization among hospitalized patients with MS. Data from the National Inpatient Sample database from 2005 to 2014 were analyzed to better understand the characteristics of patients who received palliative care and to assess whether palliative care affected hospital utilization and costs.¹A total of 444,689 patients with a primary or secondary diagnosis of MS were identified; 216,245 of these patients were excluded from this study due to missing data. A total of 228,444 patients were included in the final analysis; most patients were Caucasian (77.7%) and were women (73.3%). Overall, 28.0% of the patients were 40 to 49 years of age, 22.6% were 50 to 59 years of age, and 19.5% were 30 to 39 years of age. Patients in the study had an average of 2.6 comorbidities.¹

From 2005 to 2014, the average length of hospital stay for patients with MS decreased from 6.1 days to 5.2 days (P <.001). During the same period, there were no major changes in the in-hospital death rate; however, among patients who died in the hospital, the proportion who received palliative care increased from 7.7% to 58.8%. There were no significant changes in inflation-adjusted hospital charges per patient with MS, though crude hospital charges increased annually.¹

The results of this analysis showed a significant increase in utilization of palliative care among hospitalized patients with MS, from 0.2% in 2005 to 6.1% in 2014 (P <.001). The numerically largest single-year increase occurred between 2010 and 2011, when palliative care utilization increased from 1.5% to 4.5%. The use of palliative care gradually increased with increasing age; utilization was also higher in male patients, those who had Medicare or Medicaid (vs private insurance), and patients who required systemic procedures.¹

Palliative care utilization in hospitalized patients with MS affected hospital utilization and charges in several ways. The use of palliative care was associated with a longer hospital stay (increase in length of stay of 0.444 days, on average; P <.001). Among patients who died in the hospital, the percentage who received palliative care increased from 7.7% to 58.8%. Compared with patients who were discharged, those who died in the hospital were 14.7 times more likely to receive palliative care. Inflation-adjusted hospital charges were significantly lower among patients who received palliative care ($2261 lower per patient, on average; P <.001).¹

Conclusion

In the United States, utilization of palliative care services among hospitalized patients with MS increased by a factor of 30 from 2005 to 2014. This increase was likely due to the implementation of the Affordable Care Act. The results of this analysis also showed that the proportion of patients who died in hospital who received palliative care increased during the 10-year period evaluated. Furthermore, the use of palliative care was associated with an increased length of stay and decreased hospital cost. Among hospitalized patients with MS, earlier referral to palliative care may decrease costs and therefore enhance efficacy.¹

Reference

1. Lee YJ, Yoo JW, Hua L, Kim PC, Kim SJ, Shen JJ. Ten-year trends of palliative care utilization associated with multiple sclerosis patients in the United States from 2005 to 2014. J Clin Neurosci. 2018;58:13-19. doi: 10.1016/j.jocn.2018.10.082.