Palliative Care Inpatient Service in a Comprehensive Cancer Center: Clinical and Financial Outcomes

Purpose Inpatient palliative care units are unavailable in most cancer centers and tertiary hospitals. The purpose of this article is to review the outcomes of the first 344 admissions to the Palliative Care Inpatient Service (PCIS) at our comprehensive cancer center. Patients and Methods We retrospectively reviewed our computerized database for clinical and demographic information, length of stay, and hospital billing during the first year of the service's operation. Results Three hundred twenty patients were admitted during the study period. Their median age was 57 years. The main cancer diagnoses were thoracic or head and neck (44%), gastrointestinal (25%), and hematologic malignancy (8%). The main referral symptoms were pain (44%), nausea (41%), fatigue (39%), and dyspnea (38%). The median length of stay in the PCIS was 7 days (range, 1 to 58 days). Fifty-nine patients died while in the PCIS. However, the overall hospital mortality rate was not increased compared with that in the year before the establishment of the PCIS (3.58% v 3.59%). The mean reimbursement rate for all palliative care charges was approximately 57%, and the mean daily charges in the PCIS were 38% lower than the mean daily charges for the rest of the hospital. Symptom intensity data showed severe distress on admission and significant improvement in the main target symptoms. Most patients were discharged to a hospice. Conclusion The PCIS has been accepted in our tertiary cancer center on the basis of its clinical utility and financial viability.

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Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: A retrospective descriptive study

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2003.10.011 ◽

2004 ◽

Vol 27 (6) ◽

pp. 481-491 ◽

Cited By ~ 106

Author(s):

Florian Strasser ◽

Catherine Sweeney ◽

Jie Willey ◽

Susanne Benisch-Tolley ◽

J.Lynn Palmer ◽

...

Keyword(s):

Palliative Care ◽

Patient Satisfaction ◽

Outpatient Clinic ◽

Symptom Control ◽

Descriptive Study ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Symptom Intensity

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Acute palliative care unit in a comprehensive cancer center (CCC): Financial and clinical outcomes

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20518 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20518-e20518 ◽

Cited By ~ 1

Author(s):

A. F. Elsayem ◽

D. Hui ◽

Z. Li ◽

M. Flores ◽

W. A. Atkinson ◽

...

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Clinical Outcomes ◽

Symptom Control ◽

Health Care Facilities ◽

Comprehensive Cancer Center ◽

Rank Test ◽

Cancer Center ◽

Major Barrier ◽

Cancer Centers

e20518 Background: Acute palliative care units (APCU) in CCCs improves symptom control for advanced cancer patients and supports their families. However, these services are not available in the majority of cancer centers. Concerns regarding financial reimbursements represent a major barrier for establishing APCUs. The purpose of this study is to report the clinical outcomes and compare the financial outcomes of our APCU as compared to other services at our CCC. Methods: We reviewed all admissions to the APCU over the last 5 fiscal years for demographic information, length of stay, discharges, survival, hospital billings and collection of charges, and compared these to the rest of the institution. Results: 2,510 unique patients were admitted to the APCU. Median age was 59 years (19–101) and 51% were female. The median length of stay in APCU was 8 days (Q1-Q3 6–10). Median survival of patients discharged home, to health care facilities and hospice were 53, 22, and 13 days, respectively (p<0.001, log rank test), with 6 month survival of 20%, 4%, and 2%, respectively. Professional collections ranged from 42–47% of charges for APCU, vs. 32–38% for rest of the CCC and were stable over the 5 year period. Hospital collections were 47–51% of charges for APCU, vs. 55–57% for the rest of the CCC. The payer mix included commercial 1155 (46%), Medicare 755 (30%), Medicaid 126 (5%), mixed 127 (5%), indigent 198 (8%), and others 149 (6%). Conclusions: The ACPU has reimbursement outcomes consistent with the American acute care model and comparable to the rest of the CCC for last 5 years. The APCU is as viable as any other clinical programs in our institution. Further research is needed to investigate possible reasons for lack of APCU in cancer centers. No significant financial relationships to disclose.

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Screening for Palliative Care: Implementation of the NCCN Guideline at a Comprehensive Cancer Center (418-A)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2011.12.123 ◽

2012 ◽

Vol 43 (2) ◽

pp. 387-388 ◽

Cited By ~ 1

Author(s):

Paul Glare ◽

Kathy Plakovic ◽

Barbara Egan ◽

David Kelsen

Keyword(s):

Palliative Care ◽

Comprehensive Cancer Center ◽

Cancer Center

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Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center

Cancer ◽

10.1002/cncr.24942 ◽

2010 ◽

Vol 116 (8) ◽

pp. 2036-2043 ◽

Cited By ~ 34

Author(s):

David Hui ◽

Ahmed Elsayem ◽

Zhijun Li ◽

Maxine De La Cruz ◽

J. Lynn Palmer ◽

...

Keyword(s):

Palliative Care ◽

Antineoplastic Therapy ◽

Advanced Cancer ◽

Palliative Care Unit ◽

Comprehensive Cancer Center ◽

Cancer Center

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Interval between first palliative care consultation and death among patients in a comprehensive cancer center in Saudi Arabia

Journal of Health Specialties ◽

10.4103/1658-600x.156107 ◽

2015 ◽

Vol 3 (2) ◽

pp. 61 ◽

Cited By ~ 3

Author(s):

SamiAyed Alshammary ◽

Abdullah Alsuhail ◽

BalajiP Duraisamy ◽

Savithiri Ratnapalan ◽

SaadHamad Alabdullateef

Keyword(s):

Palliative Care ◽

Saudi Arabia ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Palliative Care Consultation ◽

Care Consultation

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Work Experiences of Patients Receiving Palliative Care at a Comprehensive Cancer Center: Exploratory Analysis

Journal of Palliative Medicine ◽

10.1089/jpm.2016.0478 ◽

2017 ◽

Vol 20 (7) ◽

pp. 770-773 ◽

Cited By ~ 3

Author(s):

Paul A. Glare ◽

Tanya Nikolova ◽

Alberta Alickaj ◽

Sujata Patil ◽

Victoria Blinder

Keyword(s):

Palliative Care ◽

Exploratory Analysis ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Work Experiences

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Palliative Care in the Kyrgyz Republic

Journal of Global Oncology ◽

10.1200/jgo.2016.003905 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 35s-35s

Author(s):

Bakyt Shaimbetov ◽

Astra Arzymatova

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Pain Score ◽

Average Length ◽

Kyrgyz Republic ◽

Home Based ◽

Average Pain ◽

Palliative Care Services ◽

The Mean ◽

Care System

Abstract 55 Currently, there are 22,984 cancer patients registered in the Kyrgyz Republic. In 2014, 5,552 new patients were diagnosed with malignant tumors and 3,219 of them died the same year. Total cancer rates in the country are steadily growing with 89.1 cases/100,000 population in 2012, 89.6 cases/100,000 population in 2013 and 95.1 cases/100,000 population in 2014. With growing cancer prevalence, need for accessible and sustainable palliative care system is rapidly increasing. In 2012, a Strategy of Palliative Care Development in the Kyrgyz Republic for 2012-2016 was proposed to address provision of patient palliative care in the country. As a result, the Kyrgyz government accepted a policy of referring patients to Palliative care facilities based on medical diagnosis and, therefore, these services must be monitored for quality control. We examined developmental progress of palliative care system in the Kyrgyz Republic and its outcomes. Data were collected from 453 terminal cancer patients registered in the Department of Palliative Care of the National Oncology Center. We used the average length of stay and the subsequent place of care as process indicators, as well as changes in the mean pain score as outcome measurements. There were considerable variations among services with regards to the mean length of stay (i.e., 6 to 28 days for each admission) and subsequent place of care, even after stratification by service level. The mean change in average pain score varied from −1.5 to 2.1, and remained significant after case-mix adjustment. We discovered significant variations in palliative care services quality in relation to the average length of stay, subsequent places of care as well as alterations in the average pain score. Continuous evaluation of changes in the establishment and outcomes of palliative care services will assist in the development of comparative analysis and evaluation of public policies of the national Palliative Care system. In accordance with the Soros Foundation-Kyrgyzstan, a new initiative is currently being implemented by the National Center of Oncology: “Creating an integrated palliative care service model at home.” The purpose of this project is expansion of home-based end-of-life services provided by a multidisciplinary team for terminal patients in the city of Bishkek. As a part of the initiative, 87 patients have already received home-based palliative care assistance. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from either author.

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Costs of blood transfusion: a process-flow analysis.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.7.2364 ◽

1998 ◽

Vol 16 (7) ◽

pp. 2364-2370 ◽

Cited By ~ 61

Author(s):

S B Cantor ◽

D V Hudson ◽

B Lichtiger ◽

E B Rubenstein

Keyword(s):

Solid Tumor ◽

Hematologic Malignancy ◽

Flow Analysis ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Outpatient Basis ◽

Structured Interviews ◽

Process Flow ◽

Allogeneic Bmt ◽

Packed Rbcs

PURPOSE To determine the cost of transfusing 2 units (U) of packed RBCs at a comprehensive cancer center. METHODS We performed a process-flow analysis to identify all costs of transfusing 2 U of allogeneic packed RBCs on an outpatient basis to patients with either (1) solid tumor who did not undergo bone marrow transplantation (BMT), (2) solid tumor who underwent BMT, (3) hematologic malignancy who did not undergo BMT, (4) hematologic malignancy who underwent allogeneic BMT, or (5) hematologic malignancy who underwent autologous BMT. We conducted structured interviews to determine the personnel time used and physical resources necessary at all steps of the transfusion process. RESULTS The mean cost of a 2-U transfusion of allogeneic packed RBCs was $548, $565, $569, $569, and $566 for patients with non-BMT solid tumor, BMT solid tumor, non-BMT hematologic malignancy, allogeneic BMT hematologic malignancy, and autologous BMT hematologic malignancy, respectively. Sensitivity analysis showed that total transfusion costs were sensitive to variations in the amount of clinician compensation and overhead costs, but were relatively insensitive to reasonable variations in the direct costs of blood tests and the blood itself, or the probability or extent of transfusion reaction. CONCLUSION The costs of the transfusion of packed RBCs are greater than previously analyzed, particularly in the cancer care setting.

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