Appointment utilization as a trigger for palliative care introduction: A retrospective cohort study.
BACKGROUND
Chronic kidney disease palliative care guidelines would benefit from more diverse and objectively defined health status measures.


AIM
The aim is to identify high-risk patients from administrative data and facilitate timely and uniform palliative care involvement.


DESIGN
It is a retrospective cohort study.


SETTING/PARTICIPANTS
In total, 45,368 Veterans, with chronic kidney disease Stage 3, 4, or 5, were monitored for up to 6 years and categorized into three groups, based on whether they died, started dialysis, or avoided both outcomes.


RESULTS
Patient's appointment utilization was a significant predictor for both outcomes. It separated individuals into low, medium, and high appointment utilizers. Among the low appointment utilizers, the risk of death did not change significantly, while the risk of dialysis increased. Medium appointment utilizers had a stable risk of death and a decreasing risk of dialysis. Significant appointment utilization (above 31 visits during the baseline year) helped high-risk patients avoid both outcomes of interest-death and dialysis.


CONCLUSION
Our model could justify the creation of a novel palliative care introduction trigger, as patients with medium demand for care may benefit from additional palliative care evaluation. The trigger could facilitate the uniformization of conservative treatment preparations. It could prompt messages to a managing physician when a patient crosses the threshold between low and medium appointment utilization. It may also aid in system-level policy development. Furthermore, our results highlight the benefit of significant appointment utilization among high-risk patients.
['Nenova|Zlatana|Z|0000-0001-9998-6073', 'Hotchkiss|John|J|']
D000368:Aged D000369:Aged, 80 and over D001071:Appointments and Schedules D005260:Female D006801:Humans D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D010166:Palliative Care D006435:Renal Dialysis D012189:Retrospective Studies D014481:United States
palliative care Kidney diseases dialysis survival analysis