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



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.


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.


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.


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).


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


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

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