The Effects of an Inpatient Palliative Care Team on Discharge Disposition

Brody, Abraham A.; Ciemins, Elizabeth L.; Newman, Jeffrey; Harrington, Charlene

doi:10.1089/jpm.2009.0300

Cited by 46 publications

(47 citation statements)

References 30 publications

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“…24 Patients who received a PC consultation were 3.24 times more likely to be discharged to hospice (P , .001), 1.52 times more likely to be discharged to a nursing facility, and 1.59 times more likely to be discharged home with services (P , .001). 25 In patients from New York who were insured by Medicaid, the referrals to hospice increased more than 10-fold if PC saw the patient. 26 Going home with hospice generated a 5% 30-day readmission rate versus a 25% rate for matched patients who did not go home with hospice.…”

Section: Discussionmentioning

confidence: 99%

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Isenberg

McQuade

et al. 2017

JOP

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Purpose: Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. Methods: This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. Results: The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (−25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. Conclusion: The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

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Section: Discussionmentioning

confidence: 99%

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Isenberg

McQuade

et al. 2017

JOP

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“…13 We also encourage palliative care referrals, which have been shown to increase eventual hospice referrals twoto 10-fold. [57][58][59][60][61] Similar direct-feedback methods have been…”

Section: Discussionmentioning

confidence: 99%

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Wang

Knight

Evans

et al. 2017

JOP

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Purpose: The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. Methods: We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Results: Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Conclusion: Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.

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“…An additional benefit in those EDI-PCC patients who survive may be an earlier consensus around goals of care/care plans resulting in early disposition to home/hospice, as shown by our short hospital length of stays. 14 …”

Section: Discussionmentioning

confidence: 99%

Emergency-Department-Initiated Palliative Care Consults: A Descriptive Analysis

Lamba

Nagurka

Walther

et al. 2012

Journal of Palliative Medicine

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EDI-PCC patients are young, likely secondary to traumatic and critical, sudden events. In-hospital mortality rate for EDI-PCC patients is very high (most die early and in the ED setting), signifying a trend for ED clinicians to request PC consults in those who are imminently dying. PC consult teams called to the ED should expect to provide high-priority, time-sensitive services and anticipate a high level of bereavement/emotional support for distraught and unprepared families, with major discussions around end-of-life care.

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The Effects of an Inpatient Palliative Care Team on Discharge Disposition

Cited by 46 publications

References 30 publications

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Emergency-Department-Initiated Palliative Care Consults: A Descriptive Analysis

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