Factors Influencing Mechanical Ventilation and Inpatient Palliative Care Utilization in Patients With Chronic Obstructive Pulmonary Disease

Li-Ting Kao,1,* Chun-Chieh Yang,2,* Yu-Cih Wu,3 Shian-Chin Ko,4 Yi-Shan Liang,1 Kuang-Ming Liao,5,6 Chung-Han Ho3,7,8 1Department of Respiratory Therapy, Chi-Mei Medical Center, Tainan, Taiwan; 2Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan; 3Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; 4Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan; 5Department of Internal Medicine, Chi Mei Medical Center Chiali, Tainan, Taiwan; 6Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan; 7Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 8Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Kuang-Ming Liao, Department of Internal Medicine, Chi Mei Medical Center Chiali, No. 606, Jialixing Jiali Dist, Tainan, 72263, Taiwan, Email [email protected] Chung-Han Ho, Department of Medical Research, Chi-Mei Medical Center, 901 Zhonghua Road Yongkang Dist, Tainan, 71004, Taiwan, Email [email protected]: Palliative care is underutilized for severely ill patients with advanced chronic obstructive pulmonary disease (COPD) experiencing significant symptoms during hospitalization. The impact of mechanical ventilation on inpatient palliative care utilization remains largely unexplored. In this study, we aimed to investigate inpatient palliative care utilization among hospitalized patients with COPD requiring mechanical ventilation and examine the associated risk factors and clinical outcomes.Patients and Methods: A retrospective nested case-control study was conducted using population-based claims datasets from 2017 to 2021. It included 36,848 hospitalized patients with COPD aged 40 and above, of which 16,118 (43.74%) required mechanical ventilation. Logistic regression was used to assess the association between mechanical ventilation and inpatient palliative care utilization, adjusting for relevant covariates.Results: Of the total cohort, 5,596 patients (15.19%) utilized inpatient palliative care, including 1,275 (7.91%) requiring mechanical ventilation. Age, duration of mechanical ventilation, comorbidity severity, and hospital type influenced inpatient palliative care use. Patients with a Charlson Comorbidity Index score of 1– 2 and ≥ 3 were 24.06 and 51.59 times more likely, respectively, to receive palliative care compared to those with a Charlson Comorbidity Index score of 0. Ventilated patients in medical centers or regional hospitals were more likely to receive palliative care than those in district hospitals. Patients on mechanical ventilation who received care for 8– 30 days were over twice as likely to receive palliative care compared to those who received care for shorter durations.Conclusion: Inpatient palliative care for patients with COPD was limited and varied based on the duration of mechanical ventilation and hospital type. To enhance patient-centered care, interdisciplinary teams should integrate palliative care throughout the illness journey.Keywords: COPD, hospice palliative care, mechanical ventilation, end of life care, risk factor, mortality