Hospital-Based Palliative Care Consultation: Effects on Hospital Cost

Penrod, Joan D.; Deb, Partha; Dellenbaugh, Cornelia; Burgess, James; Zhu, Carolyn W.; Christiansen, Cindy L.; Luhrs, Carol; Cortez, Therese B.; Livote, Elayne; Allen, Veleka; Morrison, R. Sean

doi:10.1089/jpm.2010.0038

Cited by 193 publications

(162 citation statements)

References 41 publications

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“…10,[23][24][25][26][27][28][29][30][31] Increased median longevity was observed among patients with small-cell lung cancer in early referral outpatient palliative care settings versus usual care. 32 Patients provided with inpatient palliative care consults were less likely to die in intensive care units and more likely to receive hospice referrals.…”

Section: Palliative Care Interventions Designed To Meet Needs Of Patimentioning

confidence: 99%

Living With Advanced Illness: Longitudinal Study of Patient, Family, and Caregiver Needs

Tallman¹,

Greenwald²,

Reidenouer³

et al. 2012

TPJ

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Section: Palliative Care Interventions Designed To Meet Needs Of Patimentioning

confidence: 99%

Living With Advanced Illness: Longitudinal Study of Patient, Family, and Caregiver Needs

Tallman¹,

Greenwald²,

Reidenouer³

et al. 2012

TPJ

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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.…”

mentioning

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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“…20 Bundled payment reimbursement could increase the use of palliative care because of its demonstrated cost savings. [7][8][9][10][11][12][13][14] CMS and private insurers should also explore reimbursing providers for telehealth consultations, which could facilitate access to specialty-level palliative care in programs that do not have physicians and in rural and other safetynet settings. 32,33 Health system managers have a responsibility to ensure that palliative care is available and of high quality.…”

Section: Discussionmentioning

confidence: 99%

“…1,6 Growth in palliative care programs has been driven in part by evidence that palliative care improves patient outcomes and satisfaction, while reducing costs associated with intensive medical care. 1,[7][8][9][10][11][12][13][14] Palliative care can be provided in settings throughout the continuum of care, but the predominant model in the United States (outside of hospice care) is the hospital consultative team model. 3 Central to this model are interprofessional teams, which can include physicians, advanced practice and other registered nurses, social workers, chaplains, pharmacists, rehabilitation therapists, direct care workers, and other clinical and nonclinical specialists.…”

mentioning

confidence: 99%

Few Hospital Palliative Care Programs Meet National Staffing Recommendations

et al. 2016

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The predominant model for palliative care delivery, outside of hospice care, is the hospital-based consultative team. Although a majority of US hospitals offer palliative care services, there has been little research on the staffing of their program teams and whether those teams meet national guidelines, such as the Joint Commission's standard of including at least one physician, an advanced practice or other registered nurse, a social worker, and a chaplain. Data from the 2012-13 annual surveys of the National Palliative Care Registry indicate that only 25 percent of participating programs met that standard based on funded positions, and even when unfunded positions were included, only 39 percent of programs met the standard. Larger palliative care programs were more likely than smaller ones to include a funded physician position, while smaller programs were more reliant upon advanced practice and registered nurses. To meet current and future palliative care needs, expanded and enhanced education, as well as supportive financing mechanisms for consultations, are needed.

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Hospital-Based Palliative Care Consultation: Effects on Hospital Cost

Abstract: Palliative care for patients hospitalized with advanced disease results in lower costs of care and less utilization of intensive care compared to similar patients receiving usual care. Selection on unobserved characteristics plays an important role in the determination of costs of care.

Cited by 193 publications

References 41 publications

Living With Advanced Illness: Longitudinal Study of Patient, Family, and Caregiver Needs

Living With Advanced Illness: Longitudinal Study of Patient, Family, and Caregiver Needs

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

Few Hospital Palliative Care Programs Meet National Staffing Recommendations

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