Digital health and inpatient palliative care: a cohort-controlled study

Singh, Baldev Malkit; Kumari-Dewat, Nisha; Ryder, Adam; Parry, Emma; Klaire, Vijay; Matthews, Dawn; Bennion, Gemma; Jennens, Hannah; Ritzenthaler, Benoit M. E.; Rayner, Sophie; Shears, Jean; Ahmed, Kamran; Sidhu, Mona; Viswanath, Ananth; Warren, Kate

Abstract

Objectives End of life has unacceptable levels of hospital admission and death. We aimed to determine the association of a novel digital specific system (Proactive Risk-Based and Data-Driven Assessment of Patients at the End of Life, PRADA) to modify such events.

Methods A cohort-controlled study of those discharged alive, who died within 90 days of discharge, comparing PRADA (n=114) with standard care (n=3730).

Results At 90 days, the PRADA group were more likely to die (78.9% vs 46.2%, p<0.001), had a shorter time to death (58±90 vs 178±186 days, p<0.001) but readmission (20.2% vs 37.9%, p<0.001) or death in hospital (4.4% vs 28.9%, p<0.001) was lower with reduced risk for a combined 90-day outcome of postdischarge non-elective admission or hospital death (OR 0.45, 95% CI 0.27–0.74, p<0.001). Tightening criteria with 1:1 matching (n=83 vs 83) showed persistent significant findings in PRADA contact with markedly reduced adverse events (OR 0.15, 95% CI 0.02–0.96, p<0.05).

Conclusions Being seen in hospital by a specialist palliative care team using the PRADA tool was associated with significantly improved postdischarge outcomes pertaining to those destined to die after discharge.

• Report Type: Research Report
• Acceptance Date: Jul 17, 2023
• Online Publication Date: Jul 25, 2023
• Publication Date: Jul 25, 2023
• Deposit Date: Aug 22, 2023
• Publisher: BMJ Publishing Group
• DOI: https://doi.org/10.1136/spcare-2023-004474
• Publisher URL: https://spcare.bmj.com/content/early/2023/07/24/spcare-2023-004474