scholarly journals Hospital-Wide Impact of Early Palliative Care Interventions on Direct Costs and Length of Stay (S734)

2018 ◽  
Vol 55 (2) ◽  
pp. 674-675 ◽  
Author(s):  
Masaya Higuchi ◽  
Jorge Luna ◽  
Craig Blinderman ◽  
Hojjat Salmasian ◽  
David Vawdrey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Direct Costs ◽  
Early Palliative Care

Discussions about hospice among patients with advanced cancer.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 53-53
Author(s):  
Lara Traeger ◽  
Emily M. Wright ◽  
Areej El-Jawahri ◽  
Emily R. Gallagher ◽  
Joseph Greer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Massachusetts General Hospital ◽  
Quality Care ◽  
Treatment Options ◽  
Cancer Type ◽  
Early Palliative Care ◽  
Oncology Care ◽  
Hospice Use ◽  
Eol Care

53 Background: Timely and effective patient-clinician communication about treatment options at the end of life (EOL) is considered essential to quality care. In this study we examined the timing and nature of first discussions about hospice. We hypothesized that earlier initiation of hospice discussions would be associated with longer hospice length of stay. Methods: We analyzed data from a randomized trial of early palliative care integrated with oncology care versus oncology care alone in patients with newly diagnosed incurable lung or non-colorectal gastrointestinal cancer at the Massachusetts General Hospital (n = 350, enrolled 5/11-7/15). Analysis included patients deceased at 1 year after last enrollment (n = 259). Electronic health records were reviewed to identify first documented hospice discussion with a medical oncology or palliative care clinician. Among hospice enrollees, we tested the association of first hospice discussion with hospice length of stay, adjusting for cancer type and randomized group. We used content analysis to explore the nature of first hospice discussions. Results: Prior to death, 79.9% of patients (54% male; M age = 64 yrs [SD = 11 yrs]) enrolled in hospice. Among hospice enrollees, 8.2% had no documented hospice discussion before enrollment. Range of time from first hospice discussion to hospice enrollment was ≤7 days (40.0%), 8-14 days (12.1%), 15-30 days (13.2%) or > 30 days (34.7%). Greater number of days between first hospice discussion and hospice enrollment was associated with more days on hospice (Beta = .14, SE = .04, p < .001). Almost half of first hospice discussions involved initiation of hospice referral. Discussions that occurred early ( > 30 days before enrollment) were varied, reflecting clinician’s provision of information; discussion of future hospice use; and initiation of dialog about patient/family areas of ambivalence or concern. Conclusions: Earlier initiation of hospice discussions was associated with more subsequent days on hospice and reflected attention to patient/family informational needs, perspectives and concerns about hospice and EOL care. Research is needed to help identify and address factors that facilitate earlier discussions with patients/families about EOL care options.

Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

2017 ◽  
Vol 31 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Peter May ◽  
Melissa M Garrido ◽  
J Brian Cassel ◽  
Amy S Kelley ◽  
Diane E Meier ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Advanced Cancer ◽  
Intervention Group ◽  
Cost Savings ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation

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.

Impact of early palliative care consultation on inpatient length of stay and discharge disposition among oncology patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 53-53
Author(s):  
Ajay Dhakal ◽  
Suvash Shrestha ◽  
Peter Homel ◽  
Beth Popp
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Health Agency ◽  
Living Condition ◽  
Advanced Illness ◽  
Early Palliative Care ◽  
Discharge Disposition ◽  
Palliative Care Consultation ◽  
To Receive

53 Background: As palliative care develops as a medical subspecialty, studies are needed to assess its impact on patient care. Studies examining the effect of inpatient palliative care consult (PCC) on the admission length of stay (LOS) for non-ICU patients have failed to demonstrate consistent results. Also, there is a paucity of data on the effect of PCC on discharge disposition. The objective of this study is to examine the effect of early PCC on the length of stay and discharge disposition among cancer patients discharged alive. Methods: A retrospective review of oncology inpatients (pts) from January 2011 to Jan 2014 of whom 307 had PCC (PC group) and 305 pts did not have PCC (NC group). Visits less than 4 days, those ending with in-hospital deaths and those with PCC called more than 3 days into the admission were excluded. Groups were randomly matched based on All Patient Refined Diagnosis Related Group (APR DRG) Severity of Illness scores. Median LOS was compared with the Mann Whitney test. Pts coming from home without services (certified home health agency, advanced illness management, hospice, skilled nursing facility, or rehabilitation center) and discharged with services were considered favorable dispositions; any discharge without services was considered unfavorable disposition; all other dispositions considered neutral. Chi Square test was used to analyze discharge disposition. Results: The demographic profiles of 2 groups were similar in age, race, religion, marital status, insurance and living condition; females were more likely to get PCC (60 % vs 44 %, p<0.001). Median (minimum, maximum) LOS for PC group was longer by 1 day: 8 (4, 76) days vs 7 (4, 251) days for NC group (p=0.003). PC group was more likely to receive a favorable discharge disposition (45 % vs 36 %); less likely to receive unfavorable discharge (13 % vs 28 %, overall p < 0.001). Neutral dispositions were similar (41% vs 35 %). Conclusions: Oncology pts with PCC have 1 day longer LOS compared to those without it but are more likely to get a favorable discharge disposition. This may favorably impact readmission rates, which we hope to study in the future.

scholarly journals Early Palliative Care Intervention Helps with Decreased Length Of Stay And Cost Cutting In A Safety Net Hospital In The Central Valley Of California.

2020 ◽  
Author(s):  
Soujanya Sodavarapu ◽  
Siamak M Seraj ◽  
Gurinder Ghotra ◽  
Malkinder Singh ◽  
Nasim Khosravi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Safety Net ◽  
Cost Of Care ◽  
Public Hospitals ◽  
Early Palliative Care ◽  
Care Intervention ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Total Charges

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.

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