Does inpatient palliative care consultation impact outcomes following hospital discharge? A narrative systematic review

Abstract

Background: While most patients desire to die at home or in a community-based hospice, the transition from hospital to community settings often lacks streamlined coordination of care to ensure that adequate support is provided in the preferred care setting. The impact of hospital-based palliative care consultations on post-discharge care and outcomes has not been extensively studied. Aim: The aim of this study was to appraise available research on the impact of inpatient palliative care consultations on transitions from hospital to community settings. Design: We conducted a narrative systematic review and used the Effective Public Health Practice Project tool to appraise the quality of selected studies. Studies were included if they assessed the transition from hospital to community and examined outcomes after an inpatient palliative care consultation. A protocol for this study was registered and published in PROSPERO, Centre for Reviews and Dissemination (ID: CRD42018094924). Data sources: We searched for quantitative studies indexed in PubMED, CINAHL and Cochrane and published between 1 January 1 2000 and 11 March 2018. Results: Our search retrieved 2749 articles. From these, 123 articles were full-text screened and 15 studies met our inclusion criteria. Studies reported that inpatient palliative care consultations are associated with high rates of discharge to community settings, greater provision of services post-discharge, improved coordination and lower rates of rehospitalization. Conclusion: Existing evidence suggest that inpatient palliative care consultations have a positive impact on patient outcomes and transitions to the community, demonstrating the potential to improve patient quality of life and relieve overburdened acute care systems.

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

“…Several recently published meta-analyses and systematic reviews point to the significant role of palliative care interventions on enhancing quality of life and reducing symptoms burden and health care cost and utilization. [161][162][163][164][165][166][167] A systematic search of 124 randomized controlled trials shows that palliative care improves outcome of many end-of-life conditions including cancer, chronic heart failure, chronic obstructive pulmonary disease, and dementia. These systematic reviews point to the effectiveness of communication and psychosocial support.…”

“…162 Moreover, reviews of current literature show that inpatient palliative care consultations have the potential to improve patient quality of life and encourage transitions to the community, thereby relieving overburdened acute care facilities. 165 Two other recent systematic reviews of palliative care for advanced heart failure patients reveal that palliative interventions substantially reduce hospitalizations, 163 improve patientcentered outcomes, documentation of preferences, and health care utilization. 164 Along the same line, another systematic review revealed that receiving palliative care was associated with lower emergency department attendance in the last year of life for older adults.…”

“… 162 Moreover, reviews of current literature show that inpatient palliative care consultations have the potential to improve patient quality of life and encourage transitions to the community, thereby relieving overburdened acute care facilities. 165 …”

Continuity in palliative care – analysis of intersectoral palliative care based on routine data of a statutory health insurance

“…The results show a difference in the number of treated patients between urban and rural regions but no differences with respect to the continuity of palliative care. Readmission of patients after discharge from inpatients palliative care can be an indication of insufficient discharge management and a lack of support in the ambulatory health care setting [18]. Other possible risk factors for hospital readmissions within 30 days include neoplasms, prescribed opiates, comorbidities and an increased number of hospitalisations in the past [19].…”

Does Inpatient Palliative Care Facilitate Home-Based Palliative Care Postdischarge? A Retrospective Cohort Study

“…2 Studies show that inpatient palliative care is associated with reduced burdensome transitions, 3 reduced health service utilization and costs, 4 and increased likelihood of death in the preferred place. 5,6 This is not surprising, as planning for care after discharge to the home setting is a key component of inpatient palliative care delivery. 7 Discharge referrals from inpatient palliative consultations can initiate patients' entry into home health care programs, 8 making it a potentially useful bridge between acute and home care.…”