Relationship Between Physical Therapy, Occupational Therapy, Palliative Care Consultations, and Hospital Length of Stay

2017 ◽  
Vol 8 (3) ◽  
pp. 106-112 ◽  
Author(s):  
Christopher Wilson ◽  
Danielle Roy
Keyword(s):  
Palliative Care ◽  
Physical Therapy ◽  
Length Of Stay ◽  
Occupational Therapy ◽  
Hospital Length ◽  
Hospital Length Of Stay

Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9592-9592
Author(s):  
A. H. Kamal ◽  
K. M. Swetz ◽  
H. Liu ◽  
S. R. Ruegg ◽  
E. C. Carey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Median Time ◽  
Mayo Clinic ◽  
Hospital Admissions ◽  
Cox Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Plan ◽  
Palliative Care Consultation

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p<0.01). Median time from PCC to death is 33 versus 11.5 days (p<0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and <6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.

Could payer mix affect length of stay or readmissions among an outpatient palliative care cohort?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 165-165
Author(s):  
Ali John Zarrabi ◽  
Karen Armstrong ◽  
Kimberly A. Curseen ◽  
Tammie E. Quest
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Commercial Insurance ◽  
Discharge Disposition

165 Background: Outpatient palliative care clinics (PCC) are a developing frontier of palliative medicine. Characterizing and promoting financially viable models for payment of services are imperative to the sustainability of PCC. There is a paucity of research addressing payer mix – meaning the breakdown of individuals and organizations that pay for a provider's services – in PCC or its impact on metrics important to quality in PC such as hospital length of stay (LOS) and hospital readmissions. We seek to describe the payer mix for our academic outpatient PC practice. Furthermore, we sought to identify if payer mix (commercial, government—Medicare, Medicaid – or self-pay) influenced hospital LOS, discharge to hospice, or readmissions. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology patients from 2014-2017 (n = 3137) using data restricted to ICD10 codes for solid tumors. We performed bivariate tests and multivariable logistic regressions to examine the main effects of length of stay (LOS), readmissions, insurance status, and discharge disposition using SAS version 9.4 (Cary, NC). Results: Payer mix included 711 (24%) commercial insurance enrollees, 2357 (75%) Medicare or Medicaid recipients, and 38 (1%) self-pay. Mean LOS was 12.7 days (SD 16.38). The majority (94%) of patients had more than 5 readmissions. Commercial insurance was associated with prolonged LOS ( > = 30 days), discharge disposition to hospice, and hospital readmissions ( > 5) compared to government insurance (p < 0.05). Of the 3137 patients, 325 (10%) expired, 1328 (42%) were discharged to hospice, while 1463 (47%) were discharged to rehab, skilled nursing facilities or home care. Conclusions: The majority of patients in our academic PCC had governmental insurance and were less likely than those with commercial insurance to have prolonged LOS, discharge to hospice, or hospital readmission. These findings provide evidence that further investigation is needed to examine the effect of payer mix on PCC and patient outcomes.

Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital – an open-label stepped-wedge cluster-randomized trial

2021 ◽  
Vol 35 (8) ◽  
pp. 1578-1589
Author(s):  
Grace M Yang ◽  
Siqin Zhou ◽  
Zhizhen Xu ◽  
Stella SL Goh ◽  
Xia Zhu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Cluster Randomized Trial ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Specialist Palliative Care ◽  
Stepped Wedge ◽  
Open Label ◽  
Model Versus ◽  
Cluster Randomized

Background: The benefit of specialist palliative care for cancer inpatients is established, but the best method to deliver specialist palliative care is unknown. Aim: To compare a consult model versus a co-rounding model; both provide the same content of specialist palliative care to individual patients but differ in the level of integration between palliative care and oncology clinicians. Design: An open-label, cluster-randomized trial with stepped-wedge design. The primary outcome was hospital length of stay; secondary outcomes were 30-day readmissions and access to specialist palliative care. ClinicalTrials.gov number NCT03330509. Setting/participants: Cancer patients admitted to the oncology inpatient service of an acute hospital in Singapore. Results: A total of 5681 admissions from December 2017 to July 2019 were included, of which 5295 involved stage 3-4 cancer and 1221 received specialist palliative care review. Admissions in the co-rounding model had a shorter hospital length of stay than those in the consult model by 0.70 days (95%CI −0.04 to 1.45, p = 0.065) for all admissions. In the sub-group of stage 3-4 cancer patients, the length of stay was 0.85 days shorter (95%CI 0.05–1.65, p = 0.038). In the sub-group of admissions that received specialist palliative care review, the length of stay was 2.62 days shorter (95%CI 0.63–4.61, p = 0.010). Hospital readmission within 30 days (OR1.03, 95%CI 0.79–1.35, p = 0.822) and access to specialist palliative care (OR1.19, 95%CI 0.90–1.58, p = 0.215) were similar between the consult and co-rounding models. Conclusions: The co-rounding model was associated with a shorter hospital length of stay. Readmissions within 30 days and access to specialist palliative care were similar.

Deaths among pancreatic cancer in-hospital, and the utilization of palliative care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16803-e16803
Author(s):  
Anup Kasi ◽  
Raed Moh'd Taiseer Al-Rajabi ◽  
Anwaar Saeed ◽  
Weijing Sun ◽  
Saqib Abbasi
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Setting ◽  
Primary Diagnosis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Utilization ◽  
Seer Data ◽  
Total Charges

e16803 Background: Pancreatic cancer has a dismal 5 year survival of 5-10%. Deaths commonly occur in-hospital as they present with acute complications. The purpose of this study is characterize this population compared to all pancreatic deaths, identify causes for admission, trends in palliative care utilization and its effect on costs and patient stay. Methods: From the years of 2002 to 2014, admissions for patients with a diagnosis of pancreatic cancer were identified using the National Inpatient Sample. Annual trends in death were compared to overalls deaths using SEER data. Trends in hospital length of stay (LOS) and total charges (TC) were assessed, as well as utilization of palliative care. The effect of palliative care utilization on hospital LOS and TC were also identified. Results: 97,389 (weighted) patient deaths occurred from 2002 to 2014, with 7,634 in 2002, compared to 7,200 in 2014. Compared to total overall deaths of 38,026 and 42,047 respectively. Signifying 25% (2002) to 21% (2014) total patients expiring in an in-patient setting. The most common billed primary diagnosis was sepsis at 15.5%, followed by acute renal failure and fluid disorder (12.5%) and liver failure (5.3%). Overall length of stay trended down from 9.0 days to 7.5 days (p < 0.001). And total charges for admission increased from $36,704 to $88,063 (p < 0.001). Palliative care consults increased from 12% in 2002 to 45% in 2014. In 2014, the TC for deaths among those who received palliative care consults was $52,612 (p < 0.001 when compared to all deaths). LOS among these patients also decreased from 7.5 days to 6.2 days. When looking at patients with sepsis who did not die, a palliative care consult decreased costs from $86,738 to $74,544 (p < 0.001). LOS was not significantly different at 8.8 days compared to 8.5 days (p = 0.15). Conclusions: A quarter of patients with pancreatic cancer die in an in-hospital setting. Palliative involvement decreased health care resource utilization. In reviewing patients who developed sepsis without in-hospital mortality, a palliative care consult decreased total charges of admission.

Palliative Care Consultation and Hospital Length of Stay

2010 ◽  
Vol 13 (6) ◽  
pp. 761-767 ◽  
Author(s):  
J. Brian Cassel ◽  
Kathleen Kerr ◽  
Steven Pantilat ◽  
Thomas J. Smith
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Palliative Care Consultation ◽  
Care Consultation

Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis

2017 ◽  
Vol 15 (6) ◽  
pp. 741-752 ◽  
Author(s):  
Xibei Liu ◽  
Yaser Dawod ◽  
Alex Wonnaparhown ◽  
Amaan Shafi ◽  
Loomee Doo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Hospital Death ◽  
Seriously Ill Patients

ABSTRACTObjective:Hospital palliative care has been shown to improve quality of life and optimize hospital utilization for seriously ill patients who need intensive care. The present review examined whether hospital palliative care in intensive care (ICU) and non-ICU settings will influence hospital length of stay and in-hospital mortality.Method:A systematic search of CINAHL/EBSCO, the Cochrane Library, Google Scholar, MEDLINE/Ovid, PubMed, and the Web of Science through 12 October 2016 identified 16 studies that examined the effects of hospital palliative care and reported on hospital length of stay and in-hospital death. Random-effects pooled odds ratios and mean differences with corresponding 95% confidence intervals were estimated. Heterogeneity was measured by theI2test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to assess the overall quality of the evidence.Results:Of the reviewed 932 articles found in our search, we reviewed the full text of 76 eligible articles and excluded 60 of those, which resulted in a final total of 16 studies for analysis. Five studies were duplicated with regard to outcomes. A total of 18,330 and 9,452 patients were analyzed for hospital length of stay and in-hospital mortality from 11 and 10 studies, respectively. Hospital palliative care increased mean hospital length of stay by 0.19 days (pooled mean difference = 0.19; 95% confidence interval [CI95%] = –2.22–2.61 days;p= 0.87;I2= 95.88%) and reduced in-hospital mortality by 34% (pooled odds ratio = 0.66;CI95%= 0.52–0.84; p < 0.01;I2= 48.82%). The overall quality of evidence for both hospital length of stay and in-hospital mortality was rated as very low and low, respectively.Significance of results:Hospital palliative care was associated with a 34% reduction of in-hospital mortality but had no correlation with hospital length of stay.

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