The goal of the proposed studies and educational plan is to develop the PI into an independent investigator with the career goal of improving geriatric critical care through evidence-based delivery of palliative and end-of- life care for oldr adults in the intensive care unit (ICU). Older adults who are critically ill often undergo high- intensity care while simultaneously being at high-risk of death. This high-intensity treatment may result in significant discomfort and may not improve survival or be in-line with patients' preferences. The use of palliative care has been advocated as a strategy for realigning the intensity of care that is delivered with the intensity of care that is desired by patients and families. We have already demonstrated that among older adults, the need for palliative care consultation is common during high intensity treatment. In single-center studies, the use of palliative care in the ICU has been associated with markers of lower treatment intensity. However, with the recent expansion of palliative care programs, it is unclear if palliative care services have similar outcomes on a larger scale. Consequently, we plan to examine whether the availability of hospital- based palliative care services affects critical care outcomes for oldr adults by analyzing a merged multi-center data source created for this project. We will test the hypothesis that the presence of hospital-based palliative care services is associated with lower treatment intensity for critically ill older adults with three aims: 1) validate methods to study hospital-based palliative care services using administrative and proprietary data 2) determine if the availability of hospital-based palliative care services is associated with lower treatment intensity and 3) identify ICU and provider characteristics associated with high-penetration of palliative care within the ICU. We will accomplish these aims with quantitative methods, through analysis of a uniquely merged dataset of statewide hospital discharge data from New York State, data from the Annual American Hospital Association Survey and data from the National Palliative Care Registry, and with qualitative methods, using semi- structured interviews. This dataset will contain detailed information about patients and clinical care, hospital characteristic and operating characteristics of palliative care programs.
Older adults account for more than half of all ICU admissions in the U.S. This study will examine if effects of palliative care on treatment intensity seen in smaller studies have translated on a population-level, and will generate data to inform policies to effectively implement palliative care services for older adults in ICUs. As the population of critically ill older adults continues to grow, answering these questions is vital to ensuring high- quality care.
|Mathew, Sharon; Gershengorn, Hayley B; Hua, May (2018) Terminology for Surrogate Decision Making Varies Widely by State. J Palliat Med 21:1060-1061|
|Hua, May S; Ma, Xiaoyue; Li, Guohua et al. (2018) Derivation of data-driven triggers for palliative care consultation in critically ill patients. J Crit Care 46:79-83|
|Wunsch, Hannah; Hua, May; Walkey, Allan J et al. (2018) Evaluation of Practice Changes in the Care of Patients with Septic Shock during the U.S. Norepinephrine Shortage. Ann Am Thorac Soc 15:509-511|
|Nakagawa, Shunichi; Hua, May; Takayama, Hiroo (2018) Who is not comfortable with the term ""palliative care""-patient, family, or surgeon? J Thorac Cardiovasc Surg 155:2032-2033|
|Fonseca, Laura; Walkey, Allan J; Ma, Xiaoyue et al. (2018) Validation of the V49.86 Code for Do-Not-Resuscitate Status in Hospitalized Patients at a Single Academic Medical Center. Ann Am Thorac Soc 15:1234-1237|
|Hua, May; Ma, Xiaoyue; Morrison, R Sean et al. (2018) Association between the Availability of Hospital-based Palliative Care and Treatment Intensity for Critically Ill Patients. Ann Am Thorac Soc 15:1067-1074|
|Hua, May (2018) Psychological Outcomes after Critical Illness. Is It Time to Rethink Our Paradigm? Am J Respir Crit Care Med 197:6-7|
|Wysham, Nicholas G; Hua, May; Hough, Catherine L et al. (2017) Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs. Crit Care Med 45:e372-e378|
|Miltiades, Andrea N; Gershengorn, Hayley B; Hua, May et al. (2017) Cumulative Probability and Time to Reintubation in U.S. ICUs. Crit Care Med 45:835-842|
|Hua, May; Li, Guohua; Clancy, Caitlin et al. (2017) Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center. J Palliat Med 20:372-377|
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