Implementing Palliative Care for Stroke Patients Across Health System

According to study presented at the International Stroke Conference 2020, implementing a hospice service at tertiary academic centers to enhance palliative care delivery for high mortality stroke volume and developing an end-of-life Stroke Pathway will help in standardizing care delivery.

“Patients presenting to hospitals with devastating strokes have high mortality rates (a national quality metric) and significant needs for end-of-life care including palliative care (PC) and hospice services,” stated University of Texas researchers. 

The University of Texas hospital system includes 11 hospitals, 1 tertiary academic center/comprehensive stroke center, and 10 community hospitals. The researchers investigated mortality, early death, and palliative care/hospice utilization to understand the effectiveness of end-of-life care across their system.

Study patient data comprised a total of 4062 stroke patients: 1228 presented at the tertiary academic center and 2834 to the other 10 hospital systems. Mortality rates were observed at 12% and 6% respectively. 

According to the study abstract, the end-of-life utilization rate at the tertiary academic center (19%) is significantly higher (P<0.0001) than across the system (8%). Palliative care utilization (tertiary academic center 18% vs system 6%, P<0.0001) and hospice utilization (tertiary academic center 7% vs system 4%, P=0.0009) are significantly higher at the tertiary academic center. 

At the end-of-life, the tertiary academic center (37%) had significantly fewer (P=0.0004) patients with hospice involvement compared to the system (53%). Early deaths occurred significantly more (P<0.0001) at the tertiary academic center (7%) than across the system (2%).

“Stroke mortality and end-of-life needs are concentrated at our tertiary academic center while hospice care is based at and more utilized in the community hospitals,” concluded researchers. “Our data supports implementing a hospice service at the tertiary academic center to enhance palliative care delivery for high mortality stroke volume and developing an end-of-life Stroke Pathway to standardize care delivery.”  —Edan Stanley