Making the Case for Palliative Care at the System Level: Outcomes Data

Abstract

Early involvement of PC services emerged as advantageous to the net benefit. Given that health care's changing landscape will increasingly include bundled payment and risk holding strategies to improve quality and reduce cost in health care systems, systemwide PC will play a vital role.

Inpatient palliative care referral and 9‐month hospital readmission in patients with congestive heart failure: a linked nationwide analysis

“…In this large, nationally representative database analysis, inpatient PC visit during hospital admission for HF was associated with decreased 9‐month readmission rates. This is consistent with existing literature demonstrating decreased readmission rates in patients receiving inpatient PC involvement . The large number of patients readmitted for HF is consistent with data from a recent large database‐driven study from Dharamajan et al ., who found that 35.2% of 30‐day readmissions following a HF hospitalization were for the same diagnosis .…”

“…Inpatient PC consultation has been shown to decrease 30-day readmission rates in mixed patient populations [20][21][22][23]. However, two recent single-centre studies have not upheld this relationship in the HF population, and there remains clinical equipoise this area [24,25].…”

Validation of the V66.7 Code for Palliative Care Consultation in a Single Academic Medical Center

“…Although these studies have varied in their methodology and approach, there has been a general trend toward specialized palliative care consultation being associated with better outcomes, with improvements in survival, documen-tation of advance directives, and quality of life, as well as decreases in intensive care unit (ICU) admission, ICU length of stay, and the use of nonbeneficial life-sustaining therapies. [1][2][3][4][5] It seems that within single centers, it is possible to deliver specialized palliative care to affect the intended outcomes of improving quality of life and decreasing unnecessary treatment intensity; whether these benefits have translated outside of single-center settings is unknown. However, the ability to perform larger multicenter studies using administrative data to examine this question has been limited by the absence of accurate, efficient ways to identify patients who receive a palliative care consultation.…”

Examining the Relationships Between Ethnicity, Palliative Care and Readmissions in the Heart Failure Population

“…(2016) had a majority of Black patients within the study. Two studies focused on patients with HF (Chuang, Kim, Blank, Southern & Fausto, 2017;Wiskar, Celi, Walley, Fruhstorfer, & Rush, 2017), two studies had the majority of patients with septicemia (Bharadwaj, et al, 2016;Zalenski, et al, 2016), two studies focused on oncology patients Zhang, et al, 2017), the other studies did not have a specific patient population identified, but used a trigger for a PC consult (Gagne Henderson et al, 2017;Lathrop, & Gottfried, 2015).…”

“…The tasks and role of PC practitioners in practice varies substantially. Recent research has addressed inpatient and outpatient PC programs in non-academic center hospitals and the benefits of implementation of PC consultation earlier in care of chronic illnesses outside of oncology (Bharadwaj, et al, 2016;Hughes & Smith, 2014;Meier, 2011;Provinciali et al, 2016).…”