scholarly journals End-stage organ disease–Healthcare utilisation: Impact of palliative medicine

2021 ◽  
pp. bmjspcare-2021-003288
Author(s):  
Allyn Hum ◽  
Chun Wei Yap ◽  
Mervyn Yong Hwang Koh
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Healthcare Utilisation ◽  
Exact Matching ◽  
Inpatient Hospital ◽  
Ed Visits ◽  
End Stage

ObjectivesAlthough patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.The aims of the study were to determine if palliative care referrals reduced healthcare utilisation and if impact on healthcare utilisation was dependent on the timing of the referral.MethodsPatients with ESOD who received palliative care support were matched with those who did not using coarsened exact matching and propensity score matching, and compared in this retrospective cohort study. Primary outcomes of interests were reduction in all-cause emergency department (ED) visits and costs, reduction in all-cause tertiary hospital admissions, length of hospital stay and inpatient hospital costs.ResultsPatients with ESOD referred to palliative care experienced a reduction in the frequency of all cause ED visits and inpatient hospital admissions. Significant impact of a palliative care referral was at 3 months, rather than 1 month prior to death with a greater reduction in the frequency of ED visits, inpatient hospital admissions, length of stay and charges (p all <0.05). The most common ESOD referred to palliative care for 1110 matched patients was end-stage renal failure (57.7%), and least commonly for respiratory failure (7.6%).ConclusionPalliative care can reduce healthcare utilisation, with reduction greatest when the referral is timed earlier in the disease trajectory. Cost savings can be judiciously redirected to the development of palliative care resources for integrated support of patients and caregivers.

scholarly journals Impact of an anticipatory care planning intervention on unscheduled acute hospital care using difference-in-difference analysis

2021 ◽  
Vol 28 (1) ◽  
pp. e100305
Author(s):  
Attakrit Leckcivilize ◽  
Paul McNamee ◽  
Christopher Cooper ◽  
Robby Steel
Keyword(s):  
Hospital Stay ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Acute Hospital ◽  
Care Planning ◽  
Difference Analysis ◽  
Before And After ◽  
Ed Visits ◽  
Planning Intervention

Unscheduled admissions to hospital place great demands on the use of limited healthcare resources in health systems worldwide. A range of approaches exist to manage demand; however, interventions within hospitals have received less attention, and the evidence base on effectiveness is limited. This study aimed to assess the effectiveness of a novel intervention, implemented in National Health Service Lothian, to reduce the number of unscheduled attendances, and to estimate the impact on hospital admissions, length of hospital stay and overall total acute hospital costs.MethodsBefore and after observational study of an anticipatory care planning intervention targeted among people identified by a prediction algorithm (Scottish Patients at Risk of Readmission and Admission) as being at high risk of future unscheduled hospital admissions. The statistical significance of the difference in outcomes observed before and after implementation of the intervention between August 2014 and July 2015 was tested using difference-in-difference analysis.ResultsThe intervention was estimated to reduce the number of unscheduled hospital admissions and emergency department (ED) visits by approximately 0.36 (95% CI −0.905 to 0.191) per patient per year (based on 954 and 450 patients in the intervention and control groups, respectively). There was also non-significant reductions in length of hospital stay for unscheduled admissions and hospital costs for ED visits and inpatient care. The overall predicted effect of the intervention for the average participant was a saving of around £2912 (95% CI −7347.0 to 1523.9) per patient per year.ConclusionAn anticipatory care planning intervention focused among people judged to be at higher risk of future unscheduled hospital admissions can be effective in reducing the number of unscheduled admissions to hospital and ED visits, and may lead to an overall saving in use of hospital resources.

Cost Savings Associated with Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Breffni Hannon
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Diagnostic Imaging ◽  
Hospital Costs ◽  
Cost Savings ◽  
Direct Costs ◽  
Economic Benefits ◽  
Propensity Scoring ◽  
Clinical Benefits

Although the clinical benefits associated with hospital-based palliative care (PC) consultation teams are well established, few studies address the potential economic impact of these services. This study aimed to examine the effect of hospital-based PC teams on hospital costs for patients who died in the hospital, as well as for those discharged alive. Eight diverse hospital settings with established PC teams were chosen, and administrative data relating to direct costs (including laboratory, diagnostic imaging, pharmacy, and intensive care unit [ICU] costs) were analyzed. Propensity scoring was used to match PC patients with usual care (UC) patients. Of 2,630 PC patients who were discharged alive, net savings of $2,642 per admission were calculated, compared with 18,427 UC patients. For the 2,278 PC patients who died in the hospital, savings of $4,908 per admission were seen, when compared with 2,124 UC patients, confirming the additional economic benefits associated with hospital-based PC teams.

Pediatric Palliative Care and Inpatient Hospital Costs: A Longitudinal Cohort Study

PEDIATRICS ◽  
2015 ◽  
Vol 135 (4) ◽  
pp. 694-700 ◽  
Author(s):  
A. G. Smith ◽  
S. Andrews ◽  
S. L. Bratton ◽  
J. Sheetz ◽  
C. Feudtner ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Hospital Costs ◽  
Longitudinal Cohort Study ◽  
Pediatric Palliative Care ◽  
Longitudinal Cohort ◽  
Inpatient Hospital

Integrating Palliative Care in Outpatient Hematology Clinic Increases Patient Satisfaction, Adherence to Care and Decrease Hospital Admissions

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4785-4785 ◽  
Author(s):  
Regina Draliuk ◽  
Elisabeth Perez ◽  
Alexander Yosipovich ◽  
Meir Preis
Keyword(s):  
Palliative Care ◽  
Side Effects ◽  
Hematological Malignancies ◽  
Hospital Admissions ◽  
Treatment Plan ◽  
Patient Specific ◽  
Depression And Anxiety ◽  
Care Intervention ◽  
Gi Symptoms ◽  
Ed Visits

Abstract Introduction: Israel contains within it a unique variety of ethnic and religious groups with variable set of convictions and values. Integrating palliative care approach in routine care of patients with hematological malignancies is challenging although published data supports this approach that results in improved patient quality of life. In this study we tested the effect of this approach on adherence to the planned treatment plan and hospital admissions for symptoms management. Methods: Patients with hematological malignancies treated in Carmel Medical Center, Haifa, Israel were enrolled in our integrative palliative care program. All patients were diagnosed with hematological malignancy. Patients were in various stages of disease - during diagnosis, active treatment or follow-up. Patients were evaluated by a multidisciplinary team including a palliative care physician, palliative care nurse, treating hematologist and a social worker. Evaluation included recognition of patient's unique characteristics and identifying needs and areas for intervention. A patient specific plan was formulated based on needs and social background. We measured patient's satisfaction using a specific questioner. Adherence to care was measured by the percentage of patients that had to change treatment plan due to side effects. We measured hospital admissions for symptoms management during treatment. Results: Fifty patients were enrolled in our integrated program. The mean age of our patients was 68, 46% were women, 62% were immigrants to Israel, 12% were Arab Israelis, and 64% were married. Most patients evaluated in the clinic were prior to initiating chemotherapy treatment for the underlying disease (70%). Most common patients main complain was depression and anxiety (42%) followed by pain (26%). Other complains included GI symptoms (12%), fatigue and malaise (10%), peripheral neuropathy (6%), none (4%). Most patients were treated with pharmacological interventions (66%). Patient comprehension of their disease and treatment plan was significantly improved (81%) following palliative care intervention. The palliative care intervention significantly improved patient symptoms and 81% reported significant improvement. None of the patients had to stop or change treatment due to symptoms or side effects from therapy. A significant decrease in ED visits or inpatients admissions was noted. Over a period of 6 months there was 80% decrease in ED visits or inpatients admission for symptoms management (p=0.04). Conclusions: Integrating palliative care in the outpatient hematology clinic significantly increase patients satisfaction, adherence to care and decrease hospital admissions for symptoms management. Depression and anxiety are very significant symptoms in patients prior to chemotherapy initiation and should be addressed to improve patient care. This approach has tremendous value in treating newly diagnosed patients with hematological malignancies. Disclosures No relevant conflicts of interest to declare.

Access to Palliative Care for Patients Undergoing Mechanical Ventilation With Idiopathic Pulmonary Fibrosis in the United States

2017 ◽  
Vol 35 (3) ◽  
pp. 492-496 ◽  
Author(s):  
Barret Rush ◽  
Landon Berger ◽  
Leo Anthony Celi
Keyword(s):  
Mechanical Ventilation ◽  
Palliative Care ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Hospital Admissions ◽  
The United States ◽  
Do Not Resuscitate ◽  
Mechanically Ventilated ◽  
Inpatient Hospitalizations ◽  
End Stage

Objective: The utilization of palliative care (PC) in patients with end-stage idiopathic pulmonary fibrosis (IPF) is not well understood. Methods: The Nationwide Inpatient Sample (NIS) was utilized to examine the use of PC in mechanically ventilated (MV) patients with IPF. The NIS captures 20% of all US inpatient hospitalizations and is weighted to estimate 95% of all inpatient care. Results: A total of 55 208 382 hospital admissions from the 2006 to 2012 NIS samples were examined. There were 21 808 patients identified with pulmonary fibrosis, of which 3166 underwent mechanical ventilation and were included in the analysis. Of the 3166 patients in the main cohort, 408 (12.9%) had an encounter with PC, whereas 2758 (87.1%) did not. After multivariate logistic regression modeling, variables associated with increased access to PC referral were age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.03, P < .01), treatment in an urban teaching hospital (OR: 1.49, 95% CI: 1.27-3.58, P < .01), and do-not-resuscitate status (OR: 9.86, 95% CI: 7.48-13.00, P < .01). Factors associated with less access to PC were Hispanic race (OR: 0.64, 95% CI: 0.41-0.99, P = .04) and missing race (OR: 0.52, 95% CI: 0.34-0.79, P < .01), with white race serving as the reference. The use of PC has increased almost 10-fold from 2.3% in 2006 to 21.6% in 2012 ( P < .01). Conclusion: The utilization of PC in patients with IPF who undergo MV has increased dramatically between 2006 and 2012.

Dementia and frailty

2019 ◽  
pp. 579-618
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Advanced Disease ◽  
Psychological Symptoms ◽  
Management Strategies ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
The Uk ◽  
End Stage

This chapter outlines the symptoms, epidemiology, aetiology, and differential diagnosis of dementia, with emphasis on advanced disease. It discusses the role of dementia treatments, the challenges faced with advanced disease, and guides to recognition and treatment of common symptoms, including behavioural and psychological symptoms of dementia and pain. The chapter also discusses pharmacological and non-pharmacological approaches to management of dementia symptoms, highlighting the role of palliative care, when it is appropriate to refer, and terminal care. The chapter illustrates some of the controversial aspects of care. At the current rate there will be 850,000 people with dementia in the UK by 2015, and this number is forecast to increase to over 1 million by 2025 and over 2 million by 2051.This is contributing to one in four hospital admissions, with the health and social costs of dementia estimated to be more than stroke, heart disease, and cancer combined. Along with these worrying progressive epidemiological figures, we need to take into account the immense caring burden for families, carers, and society. End-stage dementia often falls between the cracks of specialization, with professionals feeling under-prepared for the intricacies of end-stage dementia management strategies. Palliative care has been slow in its involvement for multiple reasons, but primarily because dementia has a much slower disease trajectory than cancer, with an unclear prognosis.

Economics of Palliative Care for Cancer: Interpreting Current Evidence, Mapping Future Priorities for Research

2020 ◽  
Vol 38 (9) ◽  
pp. 980-986 ◽  
Author(s):  
Peter May ◽  
Charles Normand ◽  
R. Sean Morrison
Keyword(s):  
Palliative Care ◽  
Hospital Admissions ◽  
Complex Dynamics ◽  
Metastatic Cancer ◽  
General Pattern ◽  
Cost Savings ◽  
Primary Diagnosis ◽  
Current Evidence ◽  
Evidence Mapping ◽  
Disease Trajectory

The National Cancer Institute estimates that $154 billion will be spent on care for people with cancer in 2019, distributed across the year after diagnosis (31%), the final year of life (31%), and continuing care between those two (38%). Projections of future costs estimate persistent growth in care expenditures. Early research studies on the economics of palliative care have reported a general pattern of cost savings during inpatient hospital admissions and the end-of-life phase. Recent research has demonstrated more complex dynamics, but expanding palliative care capacity to meet clinical guidelines and population health needs seems to save costs. Quantifying these cost savings requires additional research, because there is significant variance in estimates of the effects of treatment on costs, depending on the timing of intervention, the primary diagnosis, and the overall illness burden. Because ASCO guidelines state that palliative care should be provided concurrently with other treatment from the point of diagnosis onward for all metastatic cancer, new and ambitious research is required to evaluate the cost effects of palliative care across the entire disease trajectory. We propose a series of ways to reach the guideline goals.

scholarly journals Ketogenic Diet Decreases Emergency Room Visits and Hospitalizations Related to Epilepsy

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Husam R. Kayyali ◽  
Anastasia Luniova ◽  
Ahmed Abdelmoity
Keyword(s):  
Emergency Room ◽  
Ketogenic Diet ◽  
Hospital Admissions ◽  
Refractory Epilepsy ◽  
Cost Savings ◽  
Emergency Room Visits ◽  
Tertiary Center ◽  
Ed Visits ◽  
Hospital Days ◽  
The Impact

Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD) on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months’ period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED) visits, hospitalizations, and hospital days as well as their associated charges. Results. 37 patients (57% males) were included. Their ages at time of KD initiation were (4.0±2.78) years. Twelve months after the KD initiation, the total number of ED visits was reduced by 36% with a significant decrease of associated charges (p=0.038). The number of hospital admissions was reduced by 40% and the number of hospital days was reduced by 39%. The cumulative charges showed net cost savings after 9 months when compared to the prediet baseline. Conclusion. In children with refractory epilepsy, treatment with the ketogenic diet reduces the number of ED visits and hospitalizations and their corresponding costs.

The Symptoms Prevalence, Medical Interventions, and Health Care Service Needs for Patients With End-Stage Renal Disease in a Renal Palliative Care Program

2016 ◽  
Vol 33 (10) ◽  
pp. 952-958 ◽  
Author(s):  
Annie O. Kwok ◽  
Sze-kit Yuen ◽  
David S. Yong ◽  
Doris M. Tse
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Causes Of Death ◽  
Hospital Admissions ◽  
Care Service ◽  
Health Care Service ◽  
Stage Renal Disease ◽  
End Stage

A retrospective study was conducted to evaluate the symptoms prevalence and interventions initiated in the last 2 weeks of life, health care service utilization, and causes of death of patients with end-stage renal disease (ESRD under a renal palliative care (RPC) program. A total of 335 RPC patients were included, of which 226 patients died during the study period. The 5 most prevalent symptoms were dyspnea (63.7%), fatigue (51.8%), edema (48.2%), pain (44.2%), and anorexia (38.1%); and the 5 most prevalent interventions initiated were oxygen (69.5%), parenteral infusion (67.3%), antibiotics (53.5%), bladder catheterization (44.7%), and analgesic (39.8%) in the last 2 weeks of life. Each patient received 3.5 ± 4.4 outpatient clinic visit, 3.4 ± 10.3 home care visits, and 3.1 ± 2.7 hospital admissions. Besides ESRD (51.8%), the most common causes of death were cardiovascular events (18.6%) and infection (17.2%).

Sign in / Sign up

Export Citation Format

Share Document