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Am J Hosp Palliat Care. 2018 Jul;35(7):966-971. doi: 10.1177/1049909117743475. Epub 2017 Nov 23.

Palliative Care Consultation for Goals of Care and Future Acute Care Costs: A Propensity-Matched Study.

Author information

1
1 Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
2
2 Program for Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, PA, USA.
3
3 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman Health System, Philadelphia, PA, USA.
4
4 Corporate Office of Strategic Decision Support, University of Pennsylvania, Philadelphia Health System, PA, USA.
5
5 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

BACKGROUND:

Hospitals are under increasing pressure to manage costs across multiple episodes of care. Most studies of the financial impact of palliative care have focused on costs during a single hospitalization.

OBJECTIVE:

To compare future acute health-care costs and utilization between patients who received inpatient palliative care consultation for goals of care (Palliative Care Service [PCS]) and a propensity-matched cohort of patients who did not receive palliative care consultation (non-PCS) in a single academic medical center.

METHODS:

Data were extracted from the hospital's electronic records for admissions and discharges between July 2014 and October 2016. A stratified propensity score matching was used to account for nonrandom assignment and potential inherent differences between PCS and non-PCS groups using variables of theoretical interest: age, gender, race, diagnosis, risk of mortality, and prior acute care costs.

RESULTS:

The analytical sample for this study included 41 363 patients (PCS = 1853; non-PCS = 39 510). Future acute care costs were significantly higher in the non-PCS group after propensity score matching (highest tier = US$15 654 vs US$8831; second highest tier = US$12 200 vs US$5496; P = .0001). The non-PCS group also had significantly higher future acute care utilization across all propensity tiers and outcomes including 30-day readmission ( P = .0001), number of future hospital days ( P = .0001), and number of future intensive care unit days ( P = .0001).

CONCLUSION:

Palliative care consultations for goals of care may decrease future health-care utilization with cost savings that persist into future hospitalizations.

KEYWORDS:

health services research; health-care costs; palliative care; readmissions

PMID:
29169247
DOI:
10.1177/1049909117743475
[Indexed for MEDLINE]

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