DOES EARLY PALLIATIVE CARE CONSULTATION DECREASE LENGTH OF STAY AND DIRECT COST AMONG TERMINALLY ILL PATIENTS? A MULTICENTER STUDY

CHEST Journal ◽  
2018 ◽  
Vol 154 (4) ◽  
pp. 803A
Author(s):  
ASHISH RAI ◽  
DAVID CARDONA ESTRADA ◽  
YAHYA AHMAD ◽  
SOHAIB ANSARI ◽  
KANWAL ANWAR ◽  
...  
2017 ◽  
Vol 31 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Peter May ◽  
Melissa M Garrido ◽  
J Brian Cassel ◽  
Amy S Kelley ◽  
Diane E Meier ◽  
...  

Background: Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. Aim: To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Design: Prospective multi-site cohort study (2007–2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Setting/participants: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Results: Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Conclusion: Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.


2020 ◽  
Author(s):  
Soujanya Sodavarapu ◽  
Siamak M Seraj ◽  
Gurinder Ghotra ◽  
Malkinder Singh ◽  
Nasim Khosravi ◽  
...  

Objective: To determine if early palliative care intervention within two days of hospital admission affects the length of stay and cost savings. Methods: Using a retrospective chart review, 570 patients who received palliative care consultation were reviewed between 2016 and 2018. 287 patients were seen within 2 days of days and the total 355 were seen within 3 days of admission. Data on length of stay and total charges were analyzed for both groups. Results: In the early consult group, both lengths of stay and cost of care in total charges decreased by 64% (p<0.0001) and 58% (p<0.0001), respectively. Multiple linear regressions showed everyone day increase in the date of the consultation is associated with an increase in the length of stay by 1.02 days. (R-squared 0.65, p-value <0.0001, CI 0.95-1.09). The number of palliative care consultations increased by 60% from 2016 to 2017. Conclusion: Our study reiterates the importance of a multidisciplinary approach in identifying patients who will benefit from palliative care consultation and addressing goals of care early in their hospital course. As such, our study suggests the importance of emphasizing early palliative care and its potential benefits in public hospitals.


Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (&lt;72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived &gt;24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.


2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 131-131
Author(s):  
Kazuhiro Kosugi ◽  
Fumio Omata ◽  
Yoshiyuki Fujita ◽  
Akitoshi Hayashi

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]


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