The Economic and Clinical Impact of an Inpatient Palliative Care Consultation Service: A Multifaceted Approach

Abstract

The large reduction in mean daily costs and LOS resulted in an estimated annual savings of $2.2 million in the study hospital. Our results extend the evidence base of financial and clinical benefits associated with inpatient PC programs. We recommend additional study of best practices for identifying patients and providing consultation services, in addition to progressive management support and reimbursement policy.

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.…”

“…25 Typically the study populations are patients near end of life; the survival rate during the study period for the intervention group varies between 0% and 80%, with a median of 55%.…”

Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

“…Many high-quality studies, including several randomized trials, [6][7][8] have examined the benefits of PC and shown it leads to significant improvements in patient quality of life and mood, 9 increased patient and caregiver satisfaction, 3,10,11 reduction in health care costs, [12][13][14] decreased intensive care unit (ICU) days, [15][16][17][18] hospital length of stay, physical symptomatology, and improved resource usage. 19 Despite the clear benefits of PC, the vast majority of patients who could benefit from PC are never identified or referred at any point during the course of their illness.…”