Multiple sclerosis (MS) is a chronic neuro-inflammatory disease of the central nervous system, associated with accumulation of irreversible neurological disabilities through both inflammatory relapses and progressive neurodegeneration. Patients with debilitating MS could benefit from palliative care perspectives both during relapses that lead to transient disability as well as later in the disease course when significant physical and cognitive disability have accrued. However, no data about palliative care utilization trends of MS patients are available. We examined 10-year temporal trends of palliative care and assessed independent associations of palliative care with hospital utilization and cost using the 2005–2014 national inpatient sample. The national trends of palliative care utilization in MS patients increased by 120 times from 0.2% to 6.1% during 2005–2014, particularly with the dramatic single-year increase between 2010 (1.5%) and 2011 (4.5%). Moreover, the proportion of receiving palliative care in in-hospital death gradually increased from 7.7% in 2005 to 58.8% in 2014. Palliative care in MS inpatients may affect hospital utilization and charges in different ways. Hospital palliative care was associated with increased length of stay (LOS) (β = 0.444 days, p < 0.001) and in-hospital death (OR = 15.35, 95% CI [13.76, 17.12]), but associated with decreased hospital charges (β = −$2261, p < 0.001). 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 patients with higher risk of in-hospital death. Moreover, palliative care was associated with reduced hospital charge with increased LOS and in-hospital death.
Bibliographical noteFunding Information:
The 2005–2014 National Inpatient Sample (NIS) database was used to obtain a population-based estimate of national trends for multiple sclerosis. The NIS database is a tool developed as a part of the Healthcare Cost and Utilization Project (HCUP) and is sponsored by the Agency for Healthcare Research and Quality (AHRQ). A comprehensive synopsis on NIS data is available at http://www.hcup-us.ahrq.gov  . The immense size of the NIS database provides an exceptional sample representation of the general US population. The NIS is the largest publicly available all-payer inpatient database in the US and includes data from over 7 million hospital inpatient stays each year. It is designed to approximate a 20% sample of nonfederal community hospitals from over 40 states in the US and is capable of estimating the delivery of approximately 96% of all hospital inpatient stays in 2014  . It contains information on health care utilization of hospitalizations classified by HCUP member hospitals and stratified by geographic region, hospital ownership, location, teaching status, bed-size, and other characteristics as indicated on the American Hospital Association Annual Survey of Hospitals. The analysis of the NIS uses completely de-identified data with no risk of confidentiality loss. We completed a data user agreement with the AHRQ prior to using the NIS database. Since the NIS database provides administrative data after a complete de-identification, an institutional review board approval was waived from University of Nevada Las Vegas. 2.2
© 2018 Elsevier Ltd
All Science Journal Classification (ASJC) codes
- Clinical Neurology
- Physiology (medical)