ObjectivesTo evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries.DesignObservational, retrospective study using propensity‐based matching.SettingA health system in southern California.ParticipantsIndividuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80.InterventionHome‐ and clinic‐based palliative care (PC) services provided by a multidisciplinary team.MeasurementsOutcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission.ResultsIntervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically.ConclusionIn the context of an alternative payment model in which the provider was “at risk” of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.

Context Inpatient palliative care is associated with reduced costs, but the optimal model for providing inpatient palliative care is unknown. Objectives To estimate the effect of palliative care consultations (PCC) and care in a palliative care unit (PCU) on cost of care, in comparison with usual care (UC) only and in comparison with each other. Methods Retrospective cohort study, using multinomial propensity scoring to control for observed confounding between treatment groups. Participants were adults admitted as inpatients between 2009 and 2015 with at least one of seven life-limiting conditions who died within a year of admission (N=6,761). Results Palliative care within 10 days of admission is estimated to reduce costs compared to UC in the case of both PCU (−$6333; 95% CI: −7871 to −4795; p<0.001) and PCC (−$3559; −5732 to −1387; p<0.001). PCU is estimated to reduce costs compared to PCC (−$2774; −5107 to −441; p=0.02) and LOS compared to UC (−1.5 days; −2.2 to −0.9; p<0.001). The comparatively larger effect of PCU over PCC is not observable when the treatment groups are restricted to those who received palliative care early in their admission (within six days). Conclusions Both PCU and PCC are associated with lower hospital costs than usual care. PCU is associated with a greater cost-avoidance effect than PCC except where both interventions are provided early in the hospitalization. Both timely provision of palliative care for appropriate patients and creation of more PCUs may decrease hospital costs.

PURPOSE Clinical trials determine safety and efficacy of cancer therapeutics and establish standards of care. Minority patient participation in cancer clinical trials is dismal. We aimed to determine the impact of eligibility criteria on disparities in pancreatic ductal adenocarcinoma (PDAC) clinical trial candidacy. METHODS Traditional PDAC trial eligibility criteria were obtained from ClinicalTrials.gov. Patients with PDAC who sought care at Virginia Commonwealth University Health from 2010 to 2019 were included. Clinical data were obtained from billing codes and discrete values in the electronic medical record. Eligibility criteria differences between racial groups were determined using chi-squared tests and unconditional maximum likelihood-based odds ratios. RESULTS Among 676 patients, most identified as Black or White race (42.5% and 51.6%, respectively). Using traditional criteria, Black patients were more likely to be ineligible for participation compared with White patients (42.4% v 33.2%, P = .023) secondary to hypoalbuminemia (14.1% v 7.9%, P = .023), HIV (3.1% v 0.3%, P = .010), hepatitis B (1.7% v 0%, P = .043), and hepatitis C (9.1% v 3.4%, P = .005). Black patients were also numerically more likely to be ineligible because of renal dysfunction, recent coronary stenting, and uncontrolled diabetes mellitus. Prior cancer treatment excluded fewer Black than White patients (9.1% v 14.0%, P = .072), most attributable to lower rates of neoadjuvant chemotherapy received. Strategic eligibility criteria revisions could equalize ineligibility rates between Black and White patients (26.8% v 24.8%, P = .581). CONCLUSION Traditional eligibility criteria differentially exclude Black patients from participating in PDAC clinical trials. These criteria perpetuate disparities, limit generalizability, and are often not medically justifiable. Revised criteria may improve participant diversity, without compromising safety or study results.

Although median pain scores improved at follow-up, less than half of patients were responders. Patients with AC had a significantly better response rate than NED patients and a lower pain score than NLLI patients at follow-up.

Hospital readmission rate is a ubiquitous measure of efficiency and quality. Individuals with life-limiting illnesses account heavily for admissions but evaluation is complicated by high-mortality rates. We report a retrospective cohort study examining the association between palliative care (PC) and readmissions while controlling for postdischarge mortality with a competing risks approach. Eligible participants were adult inpatients admitted to an academic, safety-net medical center (2009-2015) with at least one diagnosis of cancer, heart failure, chronic obstructive pulmonary disease, liver failure, kidney failure, AIDS/HIV, and selected neurodegenerative conditions. PC was associated with reduced 30-, 60-, and 90-day readmissions (subhazard ratios = 0.57, 0.53, and 0.52, respectively [all p < .001]). Hospital PC is associated with a reduction in readmissions, and this is not explained by higher mortality among PC patients. Performance measures only counting those alive at a given end point may underestimate systematically the effects of treatments with a high-mortality rate.

149 Background: Palliative care encounters (PCE) have been demonstrated to reduce resource utilization and costs within an inpatient setting. Little is known about influence PCE on delivery of radiation therapy (RT). We hypothesize that terminally ill cancer patients completing PCE would have increased utilization of palliative RT (PRT) with decreased fractions and overall costs. Methods: Retrospective review of 3,128 cancer patients that had at least one hospital contact within 6 months prior to death. Data from single academic institution decedent database, hospital billing claims, and radiation oncology electronic medical record (RO EMR) was combined into one database that could be queried. Results: From January 2009 to June 2011, 417 patients with soft tissue/bone/not other specified (NOS) excluding brain metastatic disease and at least one palliative contact within 6 months prior to death were identified. Palliative contact: PRT or palliative care consult or admission (PCE). 232 patients completed 321 RT courses (87% palliative, 8% curative, and 5% unknown). 18% of PRT was delivered in 1 fraction, 30% in 2-5, 4% in 6-9, 36% in 10, and 12% > 10 fractions. PRT and PCE were both completed in 48% (33% before, 13% during and 54% after delivery of RT). PCE prior to PRT vs. PCE none/during/after PRT were more likely to result in 5 or fewer PRT treatments (62% vs. 40%, p=0.0309) and there was a trend for increased delivery of single fraction PRT (18 vs. 15%). Based on timing of PCE, no increase in PRT courses per patient and no overall cost reduction was observed beyond direct cost reduction by reducing PRT fractions. Other non-significant factors included sex, race, and payer type. Majority of PCE were within 30 days prior to death 52% vs. only 44% of PRT. Conclusions: Relationship between PCE and PRT is complex and are likely compounded by factors not accounted for in this study. Despite these limitations, PCE prior to delivery of PRT correlates to reduced treatment numbers. This report highlights that overall referrals for palliative services could be integrated into comprehensive cancer much earlier and in a more multi-disciplinary way.

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