A High-Volume Specialist Palliative Care Unit and Team May Reduce In-Hospital End-of-Life Care Costs

Smith, Thomas J.; Coyne, Patrick; Cassel, Brian; Penberthy, Lynne; Hopson, Alison; Hager, Mary Ann

doi:10.1089/109662103322515202

Cited by 223 publications

(147 citation statements)

References 16 publications

(11 reference statements)

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“…Palliative care has been recommended as an approach to improve the quality of care for patients with advanced illness, [2][3][4][5][6] while achieving hospital cost savings. 7 Studies show that palliative care consults are associated with decreased hospitalization cost [7][8][9][10][11][12] and length of stay 13,14 in the acute care setting. Identifying which hospitalized patients are likely to benefit most from palliative care has not been well defined.…”

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confidence: 99%

Characteristics associated with higher cost per day or longer length of stay in hospitalized patients who died during the hospitalization or were discharged to hospice

Youngwerth

Bartley

Yamashita

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Palliative care has been recommended as an approach to improve the quality of care for patients with advanced illness, while achieving hospital cost savings. However, studies are lacking that identify hospitalized patients who are more likely to have higher cost per day or length of stay (LOS) who may benefit from palliative care consultation.OBJECTIVE:Identify characteristics associated with higher cost per day or longer LOS in hospitalized patients at the end of life—those likely to benefit from palliative care consultation.DESIGN:Observational study.SETTING:Academic medical center.PATIENTS:Adult inpatients who died during the hospitalization or were discharged to hospice.INTERVENTION:None.MEASUREMENTS:We hypothesized that several patient characteristics would be associated with higher cost per day and/or longer LOS. Using administrative data, we developed univariate and multivariate models to evaluate association between these patient characteristics and cost per day and LOS.RESULTS:Patients cared for on the cardiothoracic surgery service had significantly higher cost per day ($12,937; P < 0.0001) and LOS (7.0 days; P = 0.001). Neurosurgery patients also had higher cost per day ($2255; P = 0.03), and surgical oncology patients had a longer length of stay (5.3 days; P = 0.003). Patients 65 years and older had a significantly lower cost per day (−$811; P = 0.02) and LOS (−1.8 days; P = 0.003) for each decade increase in age.CONCLUSIONS:Our data suggest that younger patients and those cared for by surgical specialty services may receive the most benefit from palliative care consultation, a finding that needs to be corroborated in other centers. Journal of Hospital Medicine 2011;6:336–343. © 2011 Society of Hospital Medicine

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confidence: 99%

Characteristics associated with higher cost per day or longer length of stay in hospitalized patients who died during the hospitalization or were discharged to hospice

Youngwerth

Bartley

Yamashita

et al. 2011

Journal of Hospital Medicine

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“…31,32 This study suggests that inpatient consultation only does not provide the same level of benefits as a combination of outpatient and inpatient palliative care. Those patients only seen by our inpatient team were usually consulted for EOL planning and almost all of these either died during that hospitalization (often after withdrawal of life support) or were sent home with hospice care for the last few days of life.…”

Section: Figmentioning

confidence: 88%

CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic

Blackhall

Read

Stukenborg

et al. 2016

Journal of Palliative Medicine

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Background: Studies suggest that outpatient palliative care can reduce hospitalization and increase hospice utilization for patients with cancer, however there are insufficient resources to provide palliative care to all patients from time of diagnosis. It is also unclear whether inpatient consultation alone provides similar benefits. A better understanding of the timing, setting, and impact of palliative care for patients with cancer is needed. Objectives: The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care. Design: The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program is a phased intervention integrating outpatient palliative care into cancer care. In Year 1 patients were referred at the discretion of their oncologist. Setting: Academic medical center. Measurements: We compared EOL hospitalization, hospice utilization, and costs of care for CARE Track patients compared to those never seen by palliative care or seen only in hospital. Results: Patients were referred a median of 72.5 days prior to death. CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups. Inpatient consultation alone did not impact these variables. However, only approximately half of patients with incurable cancers were referred to this program. Conclusion: Referral outpatient palliative care within 3 months of death improved EOL care and reduced costs, benefits not seen with inpatient care only. However, many patients were never referred, and methods of systematically identifying appropriate patients are needed.

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“…This study is one of the first to confirm the anecdotal impression among some palliative care providers that when terminally ill patients' symptoms are better treated, they may live longer. At Virginia Commonwealth University, patients who died on the palliative care unit had expenditures that were 66% less than those of patients who received usual care (7). Other studies have also confirmed a financial benefit to palliative care interventions (8)(9)(10)(11)(12)(13)(14).…”

Section: Palliative Care and The Financial Challenge To Reduce Costsmentioning

confidence: 96%

The Imperative for Hospital-Based Palliative Care: Patient, Institutional, and Societal Benefits

Fine

2004

Baylor University Medical Center Proceedings

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A High-Volume Specialist Palliative Care Unit and Team May Reduce In-Hospital End-of-Life Care Costs

Abstract: Appropriate standardized care of medically complex terminally ill patients in a high-volume, specialized unit may significantly lower cost. These results should be confirmed in a randomized study but such studies are difficult to perform.

Cited by 223 publications

References 16 publications

Characteristics associated with higher cost per day or longer length of stay in hospitalized patients who died during the hospitalization or were discharged to hospice

Characteristics associated with higher cost per day or longer length of stay in hospitalized patients who died during the hospitalization or were discharged to hospice

CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic

The Imperative for Hospital-Based Palliative Care: Patient, Institutional, and Societal Benefits

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