Background:
Hospital-based palliative care consultation is consistently associated with reduced hospitalization costs and more importantly with improved patient quality of life. As healthcare systems move toward value-based purchasing rather than fee-for-service models, understanding how palliative care consultation is associated with value-based purchasing metrics can provide evidence for expanded health system support for a greater palliative care presence.
Aim:
To understand how a palliative care consultation impacts rates of patient readmission and hospital-acquired infections associated with value-based purchasing metrics.
Design:
Retrospective propensity-matched case–control study evaluating the impact of palliative care consultation on hospital charges, hospital and intensive care unit length of stay, readmission rates, and rates of hospital-acquired conditions.
Setting/participants:
All adult patients admitted to a two hospital healthcare system over a 2-year period from 1 April 2015 to 31 March 2017. The palliative care team involved three physicians, five advanced practice providers, a social worker, and a chaplain during the study period.
Results:
A total of 3415 patients receiving a palliative consult were propensity matched to 25,028 controls. Compared to controls, cases had decreased charges per day and decreased rates of 7-, 30-, and 90-day readmissions.
Conclusion:
Through value-based purchasing, hospitals have 3% of their Medicare reimbursements at risk based on readmission rates. By clarifying prognosis and patient goals, palliative care consultation reduces readmission rates. Hospital systems may want to invest in larger palliative care programs as part of their efforts to reduce hospital readmissions.
and diuretics. We also compared LVEF at 3 months post implant. Results: Of the 146 patients evaluated, 110 patients met inclusion criteria. Of those 110 patients, 49.1% were DT LVAD patients and 78.2% were male. With regard to medical therapy, 20.9% were on Beta-Blockade, 57.2% ACEi, 10% ARB, 50% aldosterone antagonists and 70.9% on diuretic therapy. In our patient population only 9 (8%) were on what is considered OMT (Beta-blocker, ACEi/ARB and Aldosterone antagonists). The average change in left ventricular ejection fraction over the 3 month period was 6.97%. The change in LVEF for patients on OMT compared to those not on OMT was 16.88% versus 5.29%. Conclusions: In this single center, retrospective analysis, 92% of patients were not maintained on OMT with regard to systolic heart failure. Furthermore, there was a more significant increase in LVEF in patients on OMT compared to those not receiving OMT.
Methods. To improve care delivery for our nation's Veterans, the Department of Veterans Affairs (VA) developed the Diffusion of Excellence Initiative to identify and spread practices developed through quality improvement methods. One such practice is Advance Care Planning via Group Visits (ACP-GV), which uses an interactive and patient-centered group session to engage Veterans in thinking about and planning for future medical decisions. In these sessions, social workers, or other health professionals, facilitate discussions for Veterans and their trusted others. Facilitators emphasize that while completing an advance directive is voluntary, it increases the chance that their care aligns with their wishes and values and relieves trusted others of having to make these difficult decisions. In addition, ACP-GV increases the effectiveness of advance care planning through allowing Veterans to discuss and process these complex topics with other Veterans in a group session.
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