Does Modality Matter? Palliative Care Unit Associated With More Cost-Avoidance Than Consultations

May, Peter; Garrido, Melissa M.; Fabbro, Egidio Del; Noreika, Danielle; Normand, Charles; Skoro, Nevena; Cassel, J. Brian

doi:10.1016/j.jpainsymman.2017.08.011

Cited by 28 publications

(33 citation statements)

References 41 publications

(58 reference statements)

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“…This organizational norm demonstrated lack of early PC, despite numerous studies that have shown that PC delivered simultaneously with standard oncology care from the time of diagnosis leads to a better quality of life, reduced costs, and less futile treatment. [21222324] Lack of guidelines for effective collaborative practice was found to be a key contributor to this organizational norm; this requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Understanding the organization of hospital-based palliative care in a Nigerian Hospital: An ethnographic study

Agom

Poole

Allen

et al. 2019

Indian J Palliat Care

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Context:Organization and delivery of palliative care (PC) services vary from one country to another. In Nigeria, PC has continued to develop, yet the organization and scope of PC is not widely known by most clinicians and the public.Objectives:The aim of the study is to identify PC services available in a Nigerian Hospital and how they are organized.Methods:This ethnographic study, utilized documentary analysis, participant observation, and ethnographic interviews (causal chat during observation and individual interviews) to gather data from members of PC team comprising doctors (n = 10), nurses (n = 4), medical social workers (n = 2), a physiotherapist, and a pharmacist, as well nurses from the oncology department (n = 3). Data were analyzed using Spradley's framework for ethnographic data analysis.Results:PC was found to be largely adult patient-centered. A hospital-based care delivery model, in the forms of family meetings, in- and out-patients' consultation services, and a home-based delivery model which is primarily home visits conducted once in a week, were the two models of care available in the studied hospital. The members of the PC team operated two shift patterns from 7:00 am to 2.00 pm and a late shift from 2:00 pm to 7:00 pm instead of 24 h service provision.Conclusions:Although PC in this hospital has made significant developmental progress, the organization and scope of services are suggestive of the need for more development, especially in manpower and collaborative care. This study provided knowledge that could be used to improve the clinical practice of PC in various cross-cultural Nigerian societies and other African context, as well as revealing areas for PC development.

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Section: Discussionmentioning

confidence: 99%

Understanding the organization of hospital-based palliative care in a Nigerian Hospital: An ethnographic study

Agom

Poole

Allen

et al. 2019

Indian J Palliat Care

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“…These policies influence medical expenditures by affecting the relative or absolute prices of medical services and product [24]. The second level mainly referred to hospital characteristic factors, such as the diagnosis and treatment level [25][26][27], hospital management [28][29][30][31][32][33] and use of advanced medical devices [34][35][36][37][38][39]. The third level mainly referred to the patients characteristics, such as age [40], gender [41], education status [42], and health status [43][44][45].…”

Section: Discussionmentioning

confidence: 99%

The effect of different classification of hospitals on medical expenditure from perspective of classification of hospitals framework: evidence from China

2020

Cost Eff Resour Alloc

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Background Different classification of hospitals (COH) have an important impact on medical expenditures in China. The objective of this study is to examine the impact of COH on medical expenditures with the hope of providing insights into appropriate care and resource allocation. Methods From the perspective of COH framework, using the Urban Employee Basic Medical Insurance (UEBMI) data of Chengdu City from 2011 to 2015, with sample size of 488,623 hospitalized patients, our study empirically analyzed the effect of COH on medical expenditure by multivariate regression modeling. Results The average medical expenditure was 5468.86 Yuan (CNY), the average expenditure of drug, diagnostic testing, medical consumables, nursing care, bed, surgery and blood expenditures were 1980.06 Yuan (CNY), 1536.27 Yuan (CNY), 500.01 Yuan (CNY), 166.23 Yuan (CNY), 221.98 Yuan (CNY), 983.18 Yuan (CNY) and 1733.21 Yuan (CNY) respectively. Patients included in the analysis were mainly elderly, with an average age of 86.65 years old. Female and male gender were split evenly. The influence of COH on total medical expenditures was significantly negative (p < 0.001). The reimbursement ratio of UEBMI had a significantly positive (p < 0.001) effect on various types of medical expenditures, indicating that the higher the reimbursement ratio was, the higher the medical expenditures would be. Conclusions COH influenced medical expenditures significantly. In consideration of reducing medical expenditures, the government should not only start from the supply side of healthcare services, but also focus on addressing the demand side.

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“…It was found that PCT consultation was associated with significant costs savings (on average €4,151 per hospital admission) for patients with cancer. Savings were higher for patients with more co‐morbidities (May, Normand, et al, ) and were mainly due to a reduced length of stay, less ICU admissions, and less medication and laboratory costs (May et al, ; May, Garrido, et al, ; Morrison et al, ; Penrod et al, ).…”

Section: Discussionmentioning

confidence: 99%

The association between palliative care team consultation and hospital costs for patients with advanced cancer: An observational study in 12 Dutch hospitals

Brinkman-Stoppelenburg

Polinder

Olij

et al. 2019

Eur J Cancer Care

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Background Early palliative care team consultation has been shown to reduce costs of hospital care. The objective of this study was to investigate the association between palliative care team (PCT) consultation and the content and costs of hospital care in patients with advanced cancer. Material and Methods A prospective, observational study was conducted in 12 Dutch hospitals. Patients with advanced cancer and an estimated life expectancy of less than 1 year were included. We compared hospital care during 3 months of follow‐up for patients with and without PCT involvement. Propensity score matching was used to estimate the effect of PCTs on costs of hospital care. Additionally, gamma regression models were estimated to assess predictors of hospital costs. Results We included 535 patients of whom 126 received PCT consultation. Patients with PCT had a worse life expectancy (life expectancy <3 months: 62% vs. 31%, p < .01) and performance status (p < .01, e.g., WHO status higher than 2:54% vs. 28%) and more often had no more options for anti‐tumour therapy (57% vs. 30%, p < .01). Hospital length of stay, use of most diagnostic procedures, medication and other therapeutic interventions were similar. The total mean hospital costs were €8,393 for patients with and €8,631 for patients without PCT consultation. Analyses using propensity scores to control for observed confounding showed no significant difference in hospital costs. Conclusions PCT consultation for patients with cancer in Dutch hospitals often occurs late in the patients’ disease trajectories, which might explain why we found no effect of PCT consultation on costs of hospital care. Earlier consultation could be beneficial to patients and reduce costs of care.

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Does Modality Matter? Palliative Care Unit Associated With More Cost-Avoidance Than Consultations

Cited by 28 publications

References 41 publications

Understanding the organization of hospital-based palliative care in a Nigerian Hospital: An ethnographic study

Understanding the organization of hospital-based palliative care in a Nigerian Hospital: An ethnographic study

The effect of different classification of hospitals on medical expenditure from perspective of classification of hospitals framework: evidence from China

The association between palliative care team consultation and hospital costs for patients with advanced cancer: An observational study in 12 Dutch hospitals

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