Differences in Healthcare Utilization at the End of Life: a Comparison Study of Three Progressive Lung Diseases

Outcomes 1. Understand differences in healthcare and palliative care utilization across lung cancer, COPD, and idiopathic pulmonary fibrosis.2. Identify potential areas of unmet palliative care needs in patients with different non-cancer lung diseases. Key Message Patients dying of COPD and IPF have lower outpatient palliative care and opioid use and higher intensive care utilization when compared to those dying of lung cancer. Our findings suggest possible unmet palliative care needs in patients dying with COPD or IPF. Abstract Patients with lung cancer (LC), idiopathic pulmonary fibrosis (IPF), or chronic obstructive pulmonary disease (COPD) frequently report high symptom burden, poor quality of life, and have high healthcare utilization at the end of life. Palliative care integration in oncology has improved these outcomes in LC, however it is unclear whether similar practice has been adopted in COPD and IPF care. We compared rates of palliative care and healthcare utilization in the last six months of life in patients with LC, COPD, and IPF.We retrospectively identified 2,343 deceased patients with LC, COPD, or IPF with ≥1 outpatient or inpatient visit at UCSF. We used registry data or previously validated algorithms to identify patients with LC, COPD, or IPF. Outcomes included metrics of outpatient and inpatient healthcare utilization. We used multivariate logistic regression controlling for demographics/co-morbidities.Compared to the LC group, patients with COPD and IPF were more likely to be white, male, older at the time of death, with fewer comorbidities (p< 0.001). Patients with COPD and IPF compared to LC were less likely to receive outpatient palliative care (adjusted probability in LC: 30%, COPD: 13%, IPF: 19%, p< 0.05) or outpatient opioids (LC: 69%, COPD: 55%, IPF: 49%, p< 0.001). Patients with COPD and IPF were more likely to receive intensive care (LC: 29%, COPD: 52%, IPF: 59%, p< 0.001), mechanical ventilation (LC: 14%, COPD: 21%, IPF: 34%, p< 0.001), and have higher inpatient palliative care utilization (LC: 28%, COPD: 38%, IPF: 44%, p=0.002) in the last six months of life.Patients dying of COPD and IPF were less likely to receive outpatient palliative care and more likely to receive intensive care when compared to LC at the end of life. Our preliminary analysis suggests possible unmet outpatient palliative care needs in patients dying with COPD or IPF and should be further explored. Keywords Disease specific management / Patient Outcomes