Economic Evaluation of a Hospital-Based Palliative Care Program

Isenberg, Sarina R.; Lu, Ching–Liang; McQuade, John P; Razzak, Rab; Weir, Brian W.; Gill, Natasha; Smith, Thomas J.; Holtgrave, David R.

doi:10.1200/jop.2016.018036

Cited by 25 publications

(29 citation statements)

References 38 publications

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“…Only one study (ACP as part of an integrated cardiology–palliative care intervention) evaluated healthcare costs, favouring intervention. These data are consistent with those from other advanced disease populations where the involvement of multidisciplinary specialist palliative care, which includes ACP as a component of care, is associated with reduced healthcare costs at the end of life, 33,35–37 and emerging data for ACP as a generic intervention. 15 As transfer of care to the community may have fewer visible costs, further careful financial analysis on the interventions is needed, including those affecting family and friends.…”

Section: Discussionsupporting

confidence: 87%

Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis

et al. 2018

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Background: People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed. Aim: To evaluate the literature regarding advance care planning in heart failure. Design: Systematic review and narrative analysis (PROSPERO CRD42017059190). Data sources: Electronic databases were searched (1990 to 23 March 2017): MEDLINE(R), Cochrane Library, CINAHL and Scopus. Four journals were hand searched. Two independent researchers screened against eligibility criteria. One reviewer extracted all data and a sample by a second. Quality was assessed by Cochrane Risk of Bias or the Critical Appraisal Skills Programme Tool for Cohort Studies. Results: Out of the 1713 articles, 8 were included representing 14,357 participants from in/outpatient settings from five countries. Two randomised controlled trials and one observational study assessed planning as part of a specialist palliative care intervention; one randomised controlled trial assessed planning in addition to usual cardiology care; one randomised controlled trial and one observational study assessed planning in an integrated cardiology-palliative care model; one observational study assessed evidence of planning (advance directive) as part of usual care and one observational study was a secondary analysis of trial participants coded Do Not Attempt Cardiopulmonary Resuscitation. Advance care planning: (1) reduced hospitalisation (5/7 studies); (2) increased referral/use of palliative services (4/4 studies); and (3) supported deaths in the patient-preferred place (2/2 studies). Conclusion: Advance care planning as part of specialist palliative care reduces hospitalisation. Preliminary studies of planning integrated into generic care, accessing specialist palliative care support if needed, are promising.

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Section: Discussionsupporting

confidence: 87%

Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis

et al. 2018

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“…However, prior work has demonstrated lower hospital costs to be associated with the early initiation of palliative care. [49][50][51][52][53] We intentionally did not adjust for co-morbidity as it is directly related to high user status and a high burden of chronic disease is recognized to define a phenotype of high cost users. 31 Moreover, our definition of high user status was based on prior acute care costs and may exclude some high cost users whose costs are related to other care settings.…”

Section: Limitationsmentioning

confidence: 99%

Association between high cost user status and end-of-life care in hospitalized patients: A national cohort study of patients who die in hospital

et al. 2021

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Background: Studies comparing end-of-life care between patients who are high cost users of the healthcare system compared to those who are not are lacking. Aim: The objective of this study was to describe and measure the association between high cost user status and several health services outcomes for all adults in Canada who died in acute care, compared to non-high cost users and those without prior healthcare use. Settings and participants: We used administrative data for all adults who died in hospital in Canada between 2011 and 2015 to measure the odds of admission to the intensive care unit (ICU), receipt of invasive interventions, major surgery, and receipt of palliative care during the hospitalization in which the patient died. High cost users were defined as those in the top 10% of acute healthcare costs in the year prior to a person’s hospitalization in which they died. Results: Among 252,648 people who died in hospital, 25,264 were high cost users (10%), 112,506 were non-high cost users (44.5%) and 114,878 had no prior acute care use (45.5%). After adjustment for age and sex, high cost user status was associated with a 14% increased odds of receiving an invasive intervention, a 15% increased odds of having major surgery, and an 8% lower odds of receiving palliative care compared to non-high cost users, but opposite when compared to patients without prior healthcare use. Conclusions: Many patients receive aggressive elements of end-of-life care during the hospitalization in which they die and a substantial number do not receive palliative care. Understanding how this care differs between those who were previously high- and non-high cost users may provide an opportunity to improve end of life care for whom better care planning and provision ought to be an equal priority.

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“…Matching care to what is really wanted has been reported to save money, multiple times in almost every setting. [5][6][7][8]…”

Section: What Did They Find?mentioning

confidence: 99%

Being Critical of Critical Care Given to People With Metastatic Cancer: Get Palliative Care Involved

Mehmood¹,

Smith²

2018

J Natl Compr Canc Netw

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Economic Evaluation of a Hospital-Based Palliative Care Program

Cited by 25 publications

References 38 publications

Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis

Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis

Association between high cost user status and end-of-life care in hospitalized patients: A national cohort study of patients who die in hospital

Being Critical of Critical Care Given to People With Metastatic Cancer: Get Palliative Care Involved

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