A193 LOW UTILIZATION OF PALLIATIVE CARE AT THE END OF LIFE WITH DECOMPENSATED LIVER DISEASE
Bibliographic record
Abstract
Liver cirrhosis is often progressive and proceeds to decompensation. In patients who are not candidates for transplantation, complications often necessitate recurrent hospital admission. We sought to characterize the patient population with end-stage chronic liver disease served by our centre and detail their health care utilization, including palliative care services. Retrospective review was conducted on adult patients with known cirrhosis who were admitted with decompensated cirrhosis to Queen Elizabeth II Health Sciences Centre in Halifax, NS, from May 2015 – May 2017, and died during their admission. Patients were identified using International Classification of Diseases-10 codes for most responsible diagnosis. Information on length of stay, etiology of underlying liver disease, decompensations, co-morbidites, complications, goals of care discussions, transplant candidacy and Model for End Stage Liver Disease Sodium (MELD-Na) score was collected. Consultations, procedures, diagnostic imaging tests, use of palliative care, admission to intensive care (ICU) and need for intubation or dialysis were detailed. Previous visits to emergency departments, clinics and endoscopy and admissions were reported for previous 6 and 12 months before death. Basic descriptive statistics and qualitative analysis were performed. A total of 28 patients with known liver cirrhosis were admitted with decompensated disease and died during study time period. Patients were aged 44 to 79 (mean 59) and 61% male with a 22-day average length of stay and mean MELD-Na score 26. Most patients (26/28; 93%) had at least one previous decompensation documented prior to admission. Stays were intensive with the following utilization: 24/28 (86%) antibiotics, 11/28 (40%) at least one endoscopy, 22/28 (79%) at least one specialist consultation, 20/28 (71%) at least three diagnostic images, 7/28 (25%) ICU admission and 4/28 (14%) new dialysis. Most patients did not have eligibility for liver transplantation detailed anywhere within their chart during hospitalization (19/28; 68%) nor documented previously (21/28; 75%). Patients had mean 3.2 emergency department visits and 2.3 clinic visits 6 months before admission, although only 13/28 (46%) saw hepatology during that time. About half of patients (15/28; 54%) were noted as “do not resuscitate” on admission and 36% (10/28) had an advanced directive, whereas only 4/28 (14%) saw palliative care prior to their death and 2/28 (7%) had documented outpatient goals of care discussions within 2 years prior to death. Patients who die in hospital with decompensated liver disease have high MELD-Na scores and prolonged admissions; however, very few have goals of care discussions in the last years of life or documentation of their eligibility for liver transplantation. CAG
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".