Effect of early palliative care on health care costs in patients with metastatic NSCLC.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6004-6004 ◽  
Author(s):  
Joseph A. Greer ◽  
Pamela M McMahon ◽  
Angela Tramontano ◽  
Emily R. Gallagher ◽  
William F. Pirl ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Outpatient Clinic ◽  
Cost Savings ◽  
Care Group ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Chemotherapy Administration ◽  
The Difference ◽  
Mean Cost

6004 Background: Introducing palliative care soon after diagnosis for patients with metastatic non-small cell lung cancer (NSCLC) leads to improvements in quality of life, mood, end-of-life care, and possibly survival. We sought to investigate whether early palliative care is also associated with health care cost savings. Methods: This secondary analysis is based on a randomized controlled trial of 151 patients with newly-diagnosed, metastatic NSCLC presenting to an outpatient clinic at a tertiary cancer center between 6/2006 and 7/2009. Participants received either early palliative care integrated with standard oncology care or standard oncology care alone. We queried participants’ electronic health records as well as our institution’s billing database to collect data on frequency and costs of outpatient clinic visits, inpatient hospitalizations, chemotherapy administration, and hospice services. The primary outcome was the difference in average resource use costs during the final month of life between groups. Results: By 18-month follow up, 133 (88.1%) participants had died, and 125 (82.8%) had available data for this analysis. Participants in the early palliative care group had a mean cost savings of $2,282 (median=$2,432) per patient in total health care expenditures during the final month of life compared to the standard care group. The difference was primarily accounted for by lower costs for inpatient visits (mean saving per patient=$3,110) and chemotherapy administration (mean saving per patient=$640). Although expenditures for outpatient clinic visits were similar between groups, the costs for hospice services were greater for the early palliative care group because of the longer lengths of stay in hospice care (mean cost per patient=$1,125). Conclusions: Early palliative care for individuals diagnosed with metastatic NSCLC not only improves multiple patient outcomes but also may be associated with lower hospital resource use costs, primarily through decreased inpatient visits and chemotherapy administration at the end of life.

Effect of Early Palliative Care on Chemotherapy Use and End-of-Life Care in Patients With Metastatic Non–Small-Cell Lung Cancer

2012 ◽  
Vol 30 (4) ◽  
pp. 394-400 ◽  
Author(s):  
Joseph A. Greer ◽  
William F. Pirl ◽  
Vicki A. Jackson ◽  
Alona Muzikansky ◽  
Inga T. Lennes ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life Care ◽  
Hospice Care ◽  
Small Cell ◽  
Life Care ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Chemotherapy Administration ◽  
Oncology Care

Purpose Prior research shows that introducing palliative care soon after diagnosis for patients with metastatic non–small-cell lung cancer (NSCLC) is associated with improvements in quality of life, mood, and survival. We sought to investigate whether early palliative care also affects the frequency and timing of chemotherapy use and hospice care for these patients. Patients and Methods This secondary analysis is based on a randomized controlled trial of 151 patients with newly diagnosed metastatic NSCLC presenting to an outpatient clinic at a tertiary cancer center from June 2006 to July 2009. Participants received either early palliative care integrated with standard oncology care or standard oncology care alone. By 18-month follow-up, 133 participants (88.1%) had died. Outcome measures included: first, number and types of chemotherapy regimens, and second, frequency and timing of chemotherapy administration and hospice referral. Results The overall number of chemotherapy regimens did not differ significantly by study group. However, compared with those in the standard care group, participants receiving early palliative care had half the odds of receiving chemotherapy within 60 days of death (odds ratio, 0.47; 95% CI, 0.23 to 0.99; P = .05), a longer interval between the last dose of intravenous chemotherapy and death (median, 64.00 days [range, 3 to 406 days] v 40.50 days [range, 6 to 287 days]; P = .02), and higher enrollment in hospice care for longer than 1 week (60.0% [36 of 60 patients] v 33.3% [21 of 63 patients]; P = .004). Conclusion Although patients with metastatic NSCLC received similar numbers of chemotherapy regimens in the sample, early palliative care optimized the timing of final chemotherapy administration and transition to hospice services, key measures of quality end-of-life care.

scholarly journals Effect of Palliative Care on Aggressiveness of End-of-Life Care Among Patients With Advanced Cancer

2017 ◽  
Vol 13 (9) ◽  
pp. e760-e769 ◽  
Author(s):  
Daniel P. Triplett ◽  
Wendi G. LeBrett ◽  
Alex K. Bryant ◽  
Andrew R. Bruggeman ◽  
Rayna K. Matsuno ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Health Care Use ◽  
Medicare Beneficiaries ◽  
Invasive Procedures ◽  
Chemotherapy Administration ◽  
Palliative Care Consultation ◽  
Care Consultation

Purpose: Palliative care’s role in oncology has expanded, but its effect on aggressiveness of care at the end of life has not been characterized at the population level. Methods: This matched retrospective cohort study examined the effect of an encounter with palliative care on health-care use at the end of life among 6,580 Medicare beneficiaries with advanced prostate, breast, lung, or colorectal cancer. We compared health-care use before and after palliative care consultation to a matched nonpalliative care cohort. Results: The palliative care cohort had higher rates of health-care use in the 30 days before palliative care consultation compared with the nonpalliative cohort, with higher rates of hospitalization (risk ratio [RR], 3.33; 95% CI, 2.87 to 3.85), invasive procedures (RR, 1.75; 95% CI, 1.62 to 1.88), and chemotherapy administration (RR, 1.61; 95% CI, 1.45 to 1.78). The opposite pattern emerged in the interval from palliative care consultation through death, where the palliative care cohort had lower rates of hospitalization (RR, 0.53; 95% CI, 0.44-0.65), invasive procedures (RR, 0.52; 95% CI, 0.45 to 0.59), and chemotherapy administration (RR, 0.46; 95% CI, 0.39 to 0.53). Patients with earlier palliative care consultation in their disease course had larger absolute reductions in health-care use compared with those with palliative care consultation closer to the end of life. Conclusion: This population-based study found that palliative care substantially decreased health-care use among Medicare beneficiaries with advanced cancer. Given the increasing number of elderly patients with advanced cancer, this study emphasizes the importance of early integration of palliative care alongside standard oncologic care.

scholarly journals Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial

2021 ◽  
Author(s):  
Hanna Sydow ◽  
Sandra Prescher ◽  
Friedrich Koehler ◽  
Kerstin Koehler ◽  
Marc Dorenkamp ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Economic ◽  
Usual Care ◽  
Usual Care Group ◽  
Cost Savings ◽  
Care Group ◽  
Interventional Management ◽  
Patients With Heart Failure ◽  
Intervention Costs

Abstract Background Noninvasive remote patient management (RPM) in patients with heart failure (HF) has been shown to reduce the days lost due to unplanned cardiovascular hospital admissions and all-cause mortality in the Telemedical Interventional Management in Heart Failure II trial (TIM-HF2). The health economic implications of these findings are the focus of the present analyses from the payer perspective. Methods and results A total of 1538 participants of the TIM-HF2 randomized controlled trial were assigned to the RPM and Usual Care group. Health claims data were available for 1450 patients (n = 715 RPM group, n = 735 Usual Care group), which represents 94.3% of the original TIM-HF2 patient population, were linked to primary data from the study documentation and evaluated in terms of the health care cost, total cost (accounting for intervention costs), costs per day alive and out of hospital (DAOH), and cost per quality-adjusted life year (QALY). The average health care costs per patient year amounted to € 14,412 (95% CI 13,284–15,539) in the RPM group and € 17,537 (95% CI 16,179–18,894) in the UC group. RPM led to cost savings of € 3125 per patient year (p = 0.001). After including the intervention costs, a cost saving of € 1758 per patient year remained (p = 0.048). Conclusion The additional noninvasive telemedical interventional management in patients with HF was cost-effective compared to standard care alone, since such intervention was associated with overall cost savings and superior clinical effectiveness. Graphical abstract

scholarly journals Integrative Approach Successfully Improves Safety of in-Patient Chemotherapy and Reduces Health Care Costs

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4524-4524
Author(s):  
Meir Preis ◽  
Ziad Abu-Salah ◽  
Ravit Melberger ◽  
Leah Zack ◽  
Judith Mohilever ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Record ◽  
Health Care Costs ◽  
Outpatient Clinic ◽  
Inpatient Setting ◽  
Chemotherapy Drugs ◽  
Chemotherapy Administration ◽  
Complex Process ◽  
Administration Time ◽  
Care Costs

Abstract Introduction Patients with hematological malignancies often require inpatient chemotherapy treatment to administer continuous infusion of chemotherapy drugs and allow better monitoring. Inpatient setting includes multiple caregivers with different level of expertise - physicians, nursing staff, pharmacy and administrators. Many patients are seen by their hematologist in an outpatient clinic where the chemotherapy plan is written. The patient is then admitted to the inpatient floor for therapy. However in many hospitals there are 2 different electronic medical record systems that don't necessarily communicate properly. In addition, the inpatient setting utilizes more health care resources and is undoubtedly more expensive than the ambulatory care. In this paper we describe an integrative process of establishing safer and better care to hematological patients admitted for inpatient chemotherapy. Methods A multidisciplinary team was established incorporating physicians, nurses, pharmacists and IT. We conducted focused observations and mapped the process. Failure Mode Effect Analysis (FMEA) was preformed to identify the most important issues needing intervention. An integrated electronic medical record interface was generated to enable online streaming of communication between different entities in the hospital - inpatient floor, outpatient clinic and pharmacy. We established a dedicated time out of the process. To assess the impact of our work we reviewed charts of randomly selected 18 patients who received inpatient chemotherapy prior to the interventions and continued to monitor records post intervention for the following indicators: 1. Percent of patients who received pre-chemo medications and fluids as prescribed by the hematologist; 2. The difference between a patient's weight on the chemotherapy orders and the actual patient weight as measured on admission; 3. The time difference variability between the planned administration time and the actual administration time of chemotherapy drugs. Results Prior to intervention, 20% of the pre-chemotherapy orders such as anti-emetics or fluids were not done according to the hematologist's request. Following the intervention, 100% of pre-chemotherapy orders were preformed accurately and timely. In 24% of patients' cases there was more than 10% difference between the weight used for chemotherapy orders and weight on admission. No significant difference was noted following intervention. In 50% of cases there was more than 2 hrs delay in chemotherapy administration on the following day. Following intervention there was no incidence of more than 2 hrs delay in chemotherapy administration. These interventions resulted in a significant decrease in hospital stay (7.4 vs. 4.7 days). Conclusions The Multidisciplinary team's approach is critical in a complex process as inpatient chemotherapy administration. FMEA is an essential tool to assess the severity of different failures of a complex process to prioritize interventions. Integrated electronic medical records interface helps improving communication between different providers and results in a better and safer patient care as well as reduces health care costs. Disclosures No relevant conflicts of interest to declare.

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.

Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non–Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care

2011 ◽  
Vol 29 (17) ◽  
pp. 2319-2326 ◽  
Author(s):  
Jennifer S. Temel ◽  
Joseph A. Greer ◽  
Sonal Admane ◽  
Emily R. Gallagher ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Oncology Care ◽  
To Receive ◽  
Over Time

Purpose Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non–small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. Patients and Methods Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. Results We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). Conclusion Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.

scholarly journals Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score–Matched Cohort Study

2021 ◽  
pp. OP.21.00299
Author(s):  
Hsien Seow ◽  
Lisa C. Barbera ◽  
Kimberlyn McGrail ◽  
Fred Burge ◽  
Dawn M. Guthrie ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Standard Deviation ◽  
Propensity Score ◽  
Control Group ◽  
Cancer Type ◽  
Early Group ◽  
Early Palliative Care ◽  
Care Costs ◽  
Average Health

PURPOSE This study aimed to investigate the impact of early versus not-early palliative care among cancer decedents on end-of-life health care costs. METHODS Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, Canada. We identified those who received early palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of not-early palliative care, hard matched on age, sex, cancer type, and stage at diagnosis. We examined differences in average health system costs (including hospital, emergency department, physician, and home care costs) between groups in the last month of life. RESULTS We identified 144,306 cancer decedents, of which 37% received early palliative care. After matching, we created 36,238 pairs of decedents who received early and not-early (control) palliative care; there were balanced distributions of age, sex, cancer type (24% lung cancer), and stage (25% stage III and IV). Overall, 56.3% of early group versus 66.7% of control group used inpatient care in the last month ( P < .001). Considering inpatient hospital costs in the last month of life, the early group used an average (±standard deviation) of $7,105 (±$10,710) versus the control group of $9,370 (±$13,685; P < .001). Overall average costs (±standard deviation) in the last month of life for patients in the early versus control group was $12,753 (±$10,868) versus $14,147 (±$14,288; P < .001). CONCLUSION Receiving early palliative care reduced average health system costs in the last month of life, especially via avoided hospitalizations.

scholarly journals A novel care guide for personalised palliative care – a national initiative for improved quality of care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dröfn Birgisdóttir ◽  
Anette Duarte ◽  
Anna Dahlman ◽  
Bengt Sallerfors ◽  
Birgit H. Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Professionals ◽  
Care Needs ◽  
Comprehensive Overview ◽  
Pilot Studies ◽  
Early Palliative Care ◽  
The Family ◽  
Palliative Care Needs

Abstract Background Even when palliative care is an integrated part of the healthcare system, the quality is still substandard for many patients and often initiated too late. There is a lack of structured guidelines for identifying and caring for patients; in particular for those with early palliative care needs. A care guide can act as a compass for best practice and support the care of patients throughout their palliative trajectory. Such a guide should both meet the needs of health care professionals and patients and families, facilitating discussion around end-of-life decision-making and enabling them to plan for the remaining time in life. The aim of this article is to describe the development and pilot testing of a novel Swedish palliative care guide. Methods The Swedish Palliative Care Guide (S-PCG) was developed according to the Medical Research Council framework and based on national and international guidelines for good palliative care. An interdisciplinary national advisory committee of over 90 health care professionals together with patient, family and public representatives were engaged in the process. The feasibility was tested in three pilot studies in different care settings. Results After extensive multi-unit and interprofessional testing and evaluation, the S-PCG contains three parts that can be used independently to identify, assess, address, follow up, and document the individual symptoms and care-needs throughout the whole palliative care trajectory. The S-PCG can provide a comprehensive overview and shared understanding of the patients’ needs and possibilities for ensuring optimal quality of life, the family included. Conclusions Based on broad professional cooperation, patients and family participation and clinical testing, the S-PCG provides unique interprofessional guidance for assessment and holistic care of patients with palliative care needs, promotes support to the family, and when properly used supports high-quality personalised palliative care throughout the palliative trajectory. Future steps for the S-PCG, entails scientific evaluation of the clinical impact and effect of S-PCG in different care settings – including implementation, patient and family outcomes, and experiences of patient, family and personnel.

scholarly journals Depression and Survival in Metastatic Non–Small-Cell Lung Cancer: Effects of Early Palliative Care

2012 ◽  
Vol 30 (12) ◽  
pp. 1310-1315 ◽  
Author(s):  
William F. Pirl ◽  
Joseph A. Greer ◽  
Lara Traeger ◽  
Vicki Jackson ◽  
Inga T. Lennes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell Lung Cancer ◽  
Survival Benefit ◽  
Small Cell ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Early Palliative Care ◽  
Metastatic Nsclc ◽  
Oncology Care

Purpose In a randomized trial, early palliative care (EPC) in patients with metastatic non–small-cell lung cancer (NSCLC) was observed to improve survival. In a secondary analysis, we explored the hypothesis that the survival benefit resulted from improving depression. Patients and Methods In total, 151 patients with newly diagnosed metastatic NSCLC participated in a randomized trial of EPC integrated with standard oncology care versus standard oncology care alone. Depression was assessed at baseline and at 12 weeks with the Patient Health Questionnaire-9 (PHQ-9) and was scored diagnostically by using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depression syndrome (MDS). Depression response was considered ≥ 50% reduction in PHQ-9 scores at 12 weeks. Survival differences were tested with log-rank and Cox proportional hazards models. Results At baseline, 21 patients (14%) met MDS criteria. MDS significantly predicted worse survival (hazard ratio, 1.82; P = .02). Patients assigned to EPC had greater improvements in PHQ-9 scores at 12 weeks (P < .001); among patients with MDS, those receiving EPC had greater rates of depression response at 12 weeks (P = .04). However, improvement in PHQ-9 scores was not associated with improved survival, except in a sensitivity analysis in which patients who died before 12 weeks were modeled to have worse depression. The group randomly assigned to EPC remained independently associated with survival after adding improvement in PHQ-9 scores to the survival model. Conclusion Depression predicted worse survival in patients with newly diagnosed metastatic NSCLC. Although EPC was associated with greater improvement in depression at 12 weeks, the data do not support the hypothesis that treatment of depression mediated the observed survival benefit from EPC.

scholarly journals Modified Palliation in Cancer Patients during COVID-19 Pandemic

2020 ◽  
Vol 4 (1) ◽  
pp. 8-10
Author(s):  
Bhawna Wagle ◽  
Eliza Koirala
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Services ◽  
Psychosocial Support ◽  
Virus Disease ◽  
Vulnerable Groups ◽  
Early Palliative Care ◽  
Health Delivery ◽  
Care Services ◽  
Demand For Health

Corona virus disease 2019 (COVID 19) has put huge challenge to the health delivery system all across the globe. The risk of mortality due to COVID 19 is highest on critically ill patients and those with preexisting disease. Palliative and end of life care are no exceptions to the surge in increased demand for health care services. It is now an essential part of global health care. The benefits of early palliative care are already well established. In the pandemic like this, we must not pull back the services, particularly in these vulnerable groups. It is important to determine how best to deliver palliative care during this crisis. It may include preparedness to shift the focus of resources to community level and the innovative use of telemedicine. Use of telemedicine is to ease patients and minimize caregiver distress, and to prevent hospitalizations. The fear of contracting COVID-19 and the emotional burden during diagnosis requires the need of continuous psychosocial support. These challenges should be handled by specialized and skilled interdisciplinary palliative care team.

Sign in / Sign up

Export Citation Format

Share Document