Utilization of Palliative Care in Veterans Admitted With Heart Failure Experiencing Homelessness

Annie Laurie Gula¹, Jacob Ramos¹, Jane M Simpson¹, Lan Jiang², Edward Martin³, Mitchell Wice⁴, Sebhat Erqou⁵, Wen-Chih Wu⁵, James L Rudolph⁶

Affiliations

¹ Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA.
² Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
³ Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA.
⁴ Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
⁵ Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA; Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
⁶ Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA. Electronic address: james.rudolph@va.gov.

PMID: 35901868
DOI: 10.1016/j.jpainsymman.2022.07.010

Utilization of Palliative Care in Veterans Admitted With Heart Failure Experiencing Homelessness

Annie Laurie Gula et al. J Pain Symptom Manage. 2022 Nov.

. 2022 Nov;64(5):471-477.

doi: 10.1016/j.jpainsymman.2022.07.010. Epub 2022 Jul 25.

Authors

Annie Laurie Gula¹, Jacob Ramos¹, Jane M Simpson¹, Lan Jiang², Edward Martin³, Mitchell Wice⁴, Sebhat Erqou⁵, Wen-Chih Wu⁵, James L Rudolph⁶

Affiliations

¹ Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA.
² Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
³ Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA.
⁴ Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
⁵ Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA; Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
⁶ Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA. Electronic address: james.rudolph@va.gov.

PMID: 35901868
DOI: 10.1016/j.jpainsymman.2022.07.010

Abstract

Context: Patients experiencing housing insecurity have numerous barriers affecting their utilization of medical care.

Objectives: Determine if housing insecurity is associated with palliative care (PC) encounters and hospice services in patients with heart failure who receive care in United States Veterans Affairs (VA) medical centers.

Methods: This retrospective study included inpatients in VA hospitals with a primary diagnosis of congestive heart failure from 2010 to 2020. Housing stability was collected from coding and separated into three cohorts: at risk for homelessness, experiencing homelessness, and stably housed. The primary outcome was a PC encounter during admission and the stably housed cohort was used as the analytic reference. Inverse-probability-weighting (IPTW) was calculated to adjust the likelihood of receiving PC during the index admission.

Results: Seventy thousand eight hundred fourty nine veterans were identified. Veterans were identified as at risk for homelessness (n=4039, 5.7%), experiencing homelessness (n=1967, 2.8%) and stably housed (n=64,843, 91.5%). PC was delivered to veterans at risk for homelessness (n=484, 12.0%), veterans experiencing homelessness, (n=161, 8.2%) and patients with stable housing (n=6249, 9.6%). Relative to the stably housed and adjusted for IPTW, those at risk for homelessness received PC services similarly (adjusted OR=1.06, 95% CI 0.94,1.19) and those experiencing homelessness were at lower odds of receiving PC services (adjusted OR=0.62, 95% CI 0.52,0.75).

Conclusion: Housing stability may be a factor in Veterans receiving PC during hospitalization for heart failure. While the logistical challenges of delivering PC and hospice to people experiencing homelessness are daunting, advocating for these services shows commitment to reducing suffering in life-limiting Illness.

Keywords: Access evaluation; Health care quality; Heart failure; Homelessness; Palliative care; Social determinants of health; Terminal care.

Published by Elsevier Inc.

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Utilization of Palliative Care in Veterans Admitted With Heart Failure Experiencing Homelessness

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Utilization of Palliative Care in Veterans Admitted With Heart Failure Experiencing Homelessness

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