The Impact of a Perinatal Palliative Care Program on Length of Stay, ICU Days, and Invasive Procedures:

Purpose: Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. Methods: This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. Results: The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (−25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. Conclusion: The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

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Palliative care impact on symptom burden.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.217 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 217-217

Author(s):

Kathleen Dunn ◽

Morgan Hannaford ◽

Scott Hartman ◽

Diane Denny, DBA ◽

Timothy Holder MD

Keyword(s):

Palliative Care ◽

Group Versus ◽

Symptom Burden ◽

Care Program ◽

Disease Stage ◽

Initial Assessment ◽

Cancer Type ◽

Palliative Care Program ◽

Patient Reported ◽

The Impact

217 Background: A national network of five hospitals piloted the use of a patient reported outcomes tool as a means for referring patients to the palliative care program. An externally validated assessment tool that captures patients’ perceived symptom burden from baseline and every 21 days was used as means of identifying patients who might benefit from referral if they met the following criteria: six or > symptoms from 27 increasing in severity by two points or > since their last assessment and determined as having any stage cancer with metastatic disease, stage 3 not in remission, or stage 4 and not already enrolled in palliative care. The data generated from the pre and post referral assessments to the palliative care program was then used to measure the impact of the program on symptom burden for this group versus those patients referred to palliative care but electing not to engage. Methods: The patient population, identified as patients who took the assessment during a selected three-month period, was reviewed to identify two groups: those who were referred through the SIT process and subsequently joined the palliative care program, and those who were referred to palliative care but chose not to attend the appointment. Results were then reviewed for both groups for a six-month period, comparing the scores from the patients’ initial assessment and their subsequent assessment. The data from both groups was compared to identify changes in scores by symptom and overall average symptom scores and the cohorts reviewed for similarities and differences (age, gender, cancer type). Results: Out of the 27 symptoms the cohort electing to utilize palliative care had higher pre-referral scores than the comparison group; and their symptoms improved at a rate greater than those not seeking palliative care. The symptoms in which the greatest impact was experienced included: activity, appetite, drowsiness, sense of family, hope, mood, and sexual interest. Conclusions: Interventions from the Palliative Care program had a positive impact on symptom burden in comparison to the group that was referred for services but did not enter the program.

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