Financial Impact of Palliative Care Consultation in a Public Hospital

Abstract

PCc significantly reduced charges in adult patients who died during their last hospitalization, even though the average LOS was higher for those who received a PCc versus those who did not.

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

“…Observational designs dominate with 9 cohort studies [23][24][25][26][28][29][30][31]33 and 1 randomized controlled trial. 27 Among observational studies there is a wide variation in size with 5 having intervention groups of between 27 and 164 patients, [23][24][25][26]28 and 1 study having 4908 intervention patients. 29 Nine of the studies restrict their perspective to the hospital and do not evaluate patient or caregiver outcomes.…”

“…29 Nine of the studies restrict their perspective to the hospital and do not evaluate patient or caregiver outcomes. [23][24][25][26][28][29][30][31]33 The remaining article analyzes total health care costs for 6 months postdischarge as well as some patient outcome measures but does not quantify the relationship between the two. 27 While there is variation in terms of hospital type and the label given to multidisciplinary teams, the composition of those teams are broadly consistent.…”

“…27 While there is variation in terms of hospital type and the label given to multidisciplinary teams, the composition of those teams are broadly consistent. Six of the 10 evaluations were described as comprising at least a physician, a nurse, a social worker, and a chaplain [23][24][25][26][27][28] ; in some cases these were also described as including a psychologist and/or an oncology nurse specialist and/or nursing assistants. Of the other 4, 2 were multisite studies in which all teams included a physician and nurse but not all included a social worker and chaplain, 29,31 and another assessed a newly implemented service that initially comprised a physician and nurse before later incorporating a chaplain.…”

“…33 Of the two studies reporting hospital charges, one reported mean daily charges around 7% lower for palliative care 23 and the other median total charges around 16% lower for palliative care. 26 The only study to take a postdischarge health costs perspective finds costs for palliative patients 32% lower than those for usual care patients over 6 months. 27 One study's reporting method precluded calculating a proportional difference.…”

“…Seven examine only costs to the hospital providing care. 24,25,[28][29][30][31]33 while two use only hospital charges, 23,26 generally considered a poor approximation of hospital costs. 34 One study examines all health care costs postdischarge but not costs to patients, caregivers, or wider systems and society.…”