Palliative Care Consultation for Goals of Care and Future Acute Care Costs: A Propensity-Matched Study

Abstract

Palliative care consultations for goals of care may decrease future health-care utilization with cost savings that persist into future hospitalizations.

Electronic Health Record Mortality Prediction Model for Targeted Palliative Care Among Hospitalized Medical Patients: a Pilot Quasi-experimental Study

“…45 We also saw a trend toward increased hospice referrals, which is consistent with findings from a retrospective study of outcomes after palliative care consultation conducted in this study's health system. 5 Coupled with the increase in ACP documentation, this suggests that implementation of Palliative Connect may facilitate delivery of goal-concordant care, although this remains an elusive outcome to directly measure. Importantly, despite more palliative care consults and ACP documentation, there was not an increase in new DNAR orders during the intervention period.…”

“…1 Hospital-based palliative care consultation has been shown to decrease length of stay (LOS), readmission rates, and health care costs. [2][3][4][5][6] Palliative care has also been shown to increase survival in some patient populations. 7 Emerging evidence further suggests that earlier palliative care consultation leads to greater family satisfaction with care.…”

“…Compared to historical controls, consultation increased by 74% (22 [16%] 23 [17%], P = .01). There were no differences between the control and intervention groups in hospice referrals (14 [10] vs 22 [16], P = .13), code status changes (42 [30] vs 39 [29]; P = .81), or consult requests for lower risk (< 0.3) patients (48/1004 [5] vs 33/798 [4]; P = .48). CONCLUSIONS: Targeting hospital-based palliative care using an EHR mortality prediction model is a clinically promising approach to improve the quality of care among seriously ill medical patients.…”

Differences in medical costs for end-of-life patients receiving traditional care and those receiving hospice care: A retrospective study

“…Therefore, National Health Insurance (NHI) developed the Hospice Shared-care Program to improve the rate of hospice care use in Taiwan since 2011, to enable patients who need hospice care to be cared for by hospice care teams in acute wards instead of limiting care to hospice wards. It was hoped that through discussions with hospice teams, the correct knowledge of hospice care could be obtained, and the utilization rate of hospice could be increased [18][19][20].…”

Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis

“…11 To help providers better understand patient preferences and enable patients to make informed decisions, the National Academy of Medicine recommends health care providers engage seriously ill patients in goals-of-care discussions. 12 Goals-of-care discussions, including those that occur during palliative care consultation, are associated with less aggressive treatments and lower use of intensive care, 1,[12][13][14][15][16] lower 30-day readmission rates and hospitalizations, 1,12,14,15,17 fewer in-hospital deaths and greater hospice use, 1,[13][14][15]18,19 more goal-concordant patient care, 1,16,18,20,21 and higher quality EOL care. 1,22 Goals-of-care discussions are also associated with lower EOL costs, 14,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] with one recent study finding an average savings of over US$6000 per patient.…”