scholarly journals The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarina R. Isenberg ◽  
Christopher Meaney ◽  
Peter May ◽  
Peter Tanuseputro ◽  
Kieran Quinn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Metastatic Cancer ◽  
Estimating Equation ◽  
Population Based ◽  
Future Research ◽  
Chronic Obstructive ◽  
Discharge Abstract Database ◽  
High Involvement ◽  
Hospitalization Costs ◽  
The Cost

Abstract Background Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. Methods Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. Results There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). Conclusions Increased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.

scholarly journals Care Integration Decreases Hospitalization Costs: Retrospective Cohort Study of Palliative Care Consult Service for Hospital Patients With Metastatic Cancer

2020 ◽  
Author(s):  
Antal Tamás Zemplenyi ◽  
Ágnes Csikós ◽  
Petra Fadgyas-Freyler ◽  
Marcell Csanádi ◽  
Zoltán Kaló ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Cost Of Care ◽  
Index Number ◽  
Consult Service ◽  
Complex Needs ◽  
Hospitalization Costs ◽  
The Impact

Abstract Background: Palliative Care Consult Service (PCCS) programme was established in Hungary to provide palliative care to hospitalized patients with complex needs and to manage the patients’ pathway when discharged from the hospital. The aim of this study was to measure the impact of PCCS on healthcare costs from the perspective of the payer.Methods: Study population consisted of patients with metastatic cancer (identified by TNM status or ICD-10 code), who were admitted to the Clinical Center of the University of Pécs between 1 January 2014 and 31 December 2016. Patients who did not die within 180-days from enrolment were excluded. Patients receiving services from PCCS team (intervention patients) were compared to patients receiving usual care (controls). The two populations were matched using propensity scores based on age, gender, number of tumor affected organs, Charlson comorbidity index, number of hospital admissions in the year prior to enrollment, outpatient visits in 90 days prior to hospitalization, and number of days to death. Data was obtained from electronic health records linked to claims data. Results: 197 matched pairs were identified with comparable characteristics. Mean number of hospital admissions was 2.1 and 2.5 (p =0.020); ratio of hospital deaths was 75% and 86% (p = 0.003); cost of inpatient care was 1,053 EUR and 1,300 EUR (p = 0.013); cost of home hospice care was 58 EUR and 21 EUR (p = 0.003); and total cost of care was 1,719 EUR and 1,982 EUR (p = 0.099) in the intervention and control groups, respectively. Conclusion: This study demonstrated that palliative care consult service for end-stage cancer patients with a very limited prognosis can add value to healthcare by reducing costs associated with hospital stays and unnecessary examinations and treatments. The data suggest that early initiation of palliative care could have even greater implications.

Perceptions of palliative care: Cancer and non-cancer.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 148-148
Author(s):  
Ingrid Harle ◽  
Christine Knott
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Palliative Medicine ◽  
Clinical Pathways ◽  
Metastatic Cancer ◽  
Symptom Burden ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Early Integration

148 Background: Palliative Medicine consultation is greater for cancer than non-cancer patients. Decreased symptom burden, improved survival time and quality of life, and cost savings are associated with palliative care. Most patients do not receive information about palliative care until end of life, resulting in negative outcomes. We examined perceptions and access to Palliative Medicine for persons living with advanced illnesses. The purpose was to inform the design of palliative care pathways for cancer and non-cancer diagnoses. Methods: Using Interpretive Phenomenological Analysis, patients/caregivers with metastatic cancer, chronic kidney disease, chronic obstructive pulmonary disease and advanced heart failure were interviewed. This qualitative research method explores an individual’s lived illness experience. Interviews addressed care processes, teams, understanding of palliative care and goals of care. Six reviewers read, coded, categorized interview transcripts and extracted themes. Results: Fifty interviews were completed, 36/50 with metastatic cancer or COPD. Despite different diagnoses, themes were similar. Caregiver’s responses reflected the patient’s burden and overall experience. Themes were: focused individual care; multiple dimensions of time; 24/7 home care; physical and psychological impacts; and spirituality. Perceptions about Palliative Medicine remain aligned with end of life. Conclusions: Palliative Medicine remains associated with end of life, regardless of the diagnosis. Majority had limited access to palliative care, despite pursuing information on supportive services. They also expressed high expectations of receiving such information from physicians and other providers. Results are similar to national strategies on palliative care. The project’s findings have informed the design of clinical pathways for early integration of Palliative Medicine for patients with cancer and non-cancer diagnoses.

Disparities in utilization of palliative care during terminal hospitalizations in patients with metastatic cancer: A nationwide analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19027-e19027
Author(s):  
Prasanth Lingamaneni ◽  
Krishna Rekha Moturi ◽  
Ishaan Vohra ◽  
Muhammad Zain Farooq ◽  
Shweta Gupta
Keyword(s):  
Palliative Care ◽  
Racial Disparities ◽  
End Of Life ◽  
Statistical Tests ◽  
Metastatic Cancer ◽  
Private Insurance ◽  
Temporal Trends ◽  
Teaching Hospitals ◽  
Nationwide Inpatient Sample Database ◽  
Hospitalization Costs

e19027 Background: Palliative care during the end of life is associated with greater patient satisfaction, improved quality of life and lower health care costs. Our aim was to study temporal trends of aggressive end of life care and palliative care during terminal hospitalizations in patients with metastatic cancer. We also studied disparities in palliative care in this population. Methods: Adult patients with metastatic cancer who died in the hospital from January 2012 to December 2017 were identified from the Nationwide Inpatient Sample database. Statistical tests for temporal trends of resource utilization were performed. Multivariable logistic regression was used to evaluate predictors of utilization of palliative care. Results: A total of 443,360 patients met the inclusion criteria. Mean age was 66.5 years. Patients were predominantly white (66.6%) with a slight male preponderance (51.9%). Most common primary cancers were lung (27.1%), GI tract (23.6%) and breast (7.6%). Use of chemotherapy and radiation decreased from 3.4% to 2.4% ( P < 0.001) and 2.8% to 1.4% ( P < 0.001), respectively, over the years. There was no statistically significant change in ICU care (26.6% to 27.2%, P= 0.61) or hospitalization costs ($22k to $23k, P =0.14). There was an increase in use of palliative care, from 45.7% to 61.2% ( P < 0.001). Patients were more likely to receive palliative care if they were older, female or treated at teaching hospitals. Blacks and Hispanics were less likely receive palliative care. Compared to patients insured by Medicare, those with Medicaid and private insurance were more likely to be offered palliative care. ICU care and chemotherapy predicted decreased use of palliative services. Conclusions: There is an overall trend towards increased use of palliative services and decrease in chemotherapy and radiation in terminal admissions. There are racial disparities in the utilization of palliative care services, with previous studies attributing knowledge gap, with mistrust of the system in African Americans, and language barriers in Hispanics to be causes for racial disparities. There is a need to increase efforts towards development of palliative care programs in non-academic hospitals. [Table: see text]

scholarly journals Burden of Healthcare Utilization among Chronic Obstructive Pulmonary Disease Patients with and without Cancer Receiving Palliative Care: A Population-Based Study in Taiwan

2020 ◽  
Vol 17 (14) ◽  
pp. 4980 ◽  
Author(s):  
Li-Ting Kao ◽  
Kuo-Chen Cheng ◽  
Chin-Ming Chen ◽  
Shian-Chin Ko ◽  
Ping-Jen Chen ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Healthcare Utilization ◽  
Population Based ◽  
Chronic Obstructive ◽  
Research Database ◽  
Physical Restraints ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Chronic obstructive pulmonary disease (COPD) is a chronic disease that burdens patients worldwide. This study aims to discover the burdens of health services among COPD patients who received palliative care (PC). Study subjects were identified as COPD patients with ICU and PC records between 2009 and 2013 in Taiwan’s National Health Insurance Research Database. The burdens of healthcare utilization were analyzed using logistic regression to estimate the difference between those with and without cancer. Of all 1215 COPD patients receiving PC, patients without cancer were older and had more comorbidities, higher rates of ICU admissions, and longer ICU stays than those with cancer. COPD patients with cancer received significantly more blood transfusions (Odds Ratio, OR: 1.66; 95% C.I.: 1.11–2.49) and computed tomography scans (OR: 1.88; 95% C.I.: 1.10–3.22) compared with those without cancer. Bronchoscopic interventions (OR: 0.26; 95% C.I.: 0.07–0.97) and inpatient physical restraints (OR: 0.24; 95% C.I.: 0.08–0.72) were significantly more utilized in patients without cancer. COPD patients without cancer appeared to receive more invasive healthcare interventions than those without cancer. The unmet needs and preferences of patients in the life-limiting stage should be taken into consideration for the quality of care in the ICU environment.

scholarly journals Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data

2021 ◽  
Vol 35 (6) ◽  
pp. 1158-1169
Author(s):  
Markus Krause ◽  
Bianka Ditscheid ◽  
Thomas Lehmann ◽  
Maximiliane Jansky ◽  
Ursula Marschall ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Claims Data ◽  
Population Based ◽  
Future Research ◽  
Intensive Care Treatment ◽  
Infrastructure Development ◽  
Population Based Study ◽  
Endoscopic Gastrostomy ◽  
Aggressive Interventions

Background: Comparative effectiveness of different types of palliative homecare is sparsely researched internationally—despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services. Aim: To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer. Design: Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses. Settings/participants: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients. Results: Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare ( p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477). Conclusion: Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).

scholarly journals Unraveling COVID-19-related hospital costs: The impact of clinical and demographic conditions

2020 ◽  
Author(s):  
Anna Miethke-Morais ◽  
Alex Cassenote ◽  
Heloísa Piva ◽  
Eric Tokunaga ◽  
Vilson Cobello ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hospital Costs ◽  
Population Based ◽  
Fixed Costs ◽  
Cost Component ◽  
Vaccination Programs ◽  
Hospitalization Costs ◽  
Clinical Conditions ◽  
The Cost ◽  
The Impact

ABSTRACTIntroductionAlthough patients’ clinical conditions were previously shown to be associated with coronavirus disease 2019 (COVID-19) severity and outcomes, their impact on hospital costs is not known. The economic evaluation of COVID-19 admissions allows the assessment of hospital costs associated with the treatment of these patients, including the main cost components and costs driven by demographic and clinical conditions. The aim of this study was to determine the COVID-19 hospitalization-related costs and their association with clinical conditions.MethodsProspective observational cohort study of the hospitalization costs of patients with COVID-19 admitted between March 30 and June 30, 2020, who were followed until discharge, death, or external transfer, using micro-costing methodology. The study was carried out in the Central Institute of the Hospital das Clinicas, affiliated with the Faculty of Medicine of the University of Sao Paulo, Brazil, which is the largest hospital complex in Latin America and was designated to exclusively admit COVID-19 patients during the pandemic response.ResultsThe average cost of the 3,254 admissions (51.7% of which involved intensive care unit (ICU) stays) was US$12,637.42. Overhead cost was the main cost component, followed by daily fixed costs and drugs. Sex, age and underlying hypertension (US$14,746.77), diabetes (US$15,002.12), obesity (US$18,941.55), cancer (US$10,315.06), chronic renal failure (US$15,377.84), and rheumatic (US$17,764.61), hematologic (US$15,908.25) and neurologic diseases (US$15,257.95) were significantly associated with higher costs. Age >69 years, RT-PCR-confirmed COVID-19, comorbidities, the use of mechanical ventilation, dialysis, or surgery, and poor outcomes remained significantly associated with higher costs after model adjustment.ConclusionKnowledge of COVID-19-associated hospital costs and their impact across different populations can aid in the development of a generalizable and comprehensive approach to hospital preparedness, decision-making and planning for future risk management. Determining the disease-associated costs is the first step in evaluating the cost-effectiveness of treatments and vaccination programs.SUMMARY BOXQuestionWhat are the COVID-19 hospitalization-related costs?FindingsIn this prospective cohort that was carried out in a single reference quaternary center designated for the treatment of severe cases of COVID-19, more than three thousand patients were included, and their costs of hospitalization were found to be directly related to the age and comorbidities. The costs were more than 50% higher in older patients, 10-24% higher in patients with comorbidities, and 24-200% higher when additional therapeutic procedures were required.MeaningDetermining the disease-associated costs is the first step in conducting future evaluations of the cost-effectiveness of treatments and vaccination programs, supporting their implementation with a comprehensive population-based approach.

scholarly journals Care Integration Decreases Hospitalization Costs: Retrospective Cohort Study of Palliative Care Consult Service for Hospital Patients With Metastatic Cancer

2020 ◽  
Author(s):  
Antal Tamás Zemplenyi ◽  
Ágnes Csikós ◽  
Petra Fadgyas-Freyler ◽  
Marcell Csanádi ◽  
Zoltán Kaló ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Metastatic Cancer ◽  
Consult Service ◽  
Care Integration ◽  
Hospitalization Costs ◽  
Hospital Patients

Abstract The authors have withdrawn this preprint due to author disagreement.

scholarly journals Hospitalised patients with palliative care needs: Spain and Sweden compared

2020 ◽  
pp. bmjspcare-2020-002417
Author(s):  
Anna Sandgren ◽  
Francisco P García-Fernández ◽  
Daniel Gutiérrez Sánchez ◽  
Peter Strang ◽  
Isabel M López-Medina
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Population Based ◽  
Chronic Obstructive ◽  
Care Needs ◽  
Cross Sectional ◽  
Patients With Cancer ◽  
Hospitalised Patients ◽  
Palliative Care Needs

ObjectivesThis study aimed to describe and compare symptoms, care needs and types of diagnoses in hospitalised patients with palliative care needs in Spain and Sweden.MethodsA cross-sectional, population-based study was carried out at two hospitals in both Spain and Sweden. Using a questionnaire, we performed 154 one-day inventories (n=4213) in Spain and 139 in Sweden (n=3356) to register symptoms, care needs and diagnoses. Descriptive analyses were used.ResultsThe proportion of patients with care needs in the two countries differed (Spain 7.7% vs Sweden 12.4%, p<0.001); however, the percentage of patients with cancer and non-cancer patients was similar. The most prevalent symptoms in cancer and non-cancer patients in both countries were deterioration, pain, fatigue and infection. The most common cancer diagnosis in both countries was lung cancer, although it was more common in Spain (p<0.01), whereas prostate cancer was more common among Swedish men (p<0.001). Congestive heart failure (p<0.001) was a predominant non-cancer diagnosis in Sweden, whereas in Spain, the most frequent diagnosis was dementia (p<0.001). Chronic obstructive pulmonary disease was common in both countries, although its frequency was higher in Spain (p<0.05). In total, patients with cancer had higher frequencies of pain (p<0.001) and nausea (p<0.001), whereas non-cancer patients had higher frequencies of deterioration (p<0.001) and infections (p<0.01).ConclusionsThe similarities in symptoms among the patients indicate that the main focus in care should be on patient care needs rather than diagnoses. Integrating palliative care in hospitals and increasing healthcare professional competency can result in providing optimal palliative care.

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