Nina R O'Connor1, Mary E Moyer1, Maryam Behta2, David J Casarett1. 1. 1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania. 2. 2 Program for Clinical Effectiveness and Quality Improvement, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Inpatient palliative care consultations have been shown to reduce acute care utilization by reducing length of stay, but less is known about their impact on subsequent costs including hospital readmissions. OBJECTIVE: The study's objective was to examine the impact of inpatient palliative care consultations on 30-day hospital readmissions to a large urban academic medical center. METHODS: The hospital's electronic medical record system was used to identify all live discharges between August 2013 and November 2014. After adjusting for a propensity score, readmission rates were compared between palliative care and usual care groups. RESULTS: Of the 34,541 hospitalizations included in the study, 1430 (4.1%) involved a palliative care consult. After adjusting for the propensity score, patients seen by palliative care had a lower 30-day readmission rate-adjusted odds ratio (AOR) 0.66, 0.55-0.78; p<0.001. Adjusted rates were 10.3% (95% confidence interval [CI] 8.9%-12.0%) for palliative care and 15.0% (95% CI 14.4%-15.4%) for usual care. Among all palliative care patients, consultations that involved goals of care discussions were associated with a lower readmission rate (AOR 0.36, 0.27-0.48; p<0.001), but consultations involving symptom management were not (AOR 1.05, 0.82-1.35; p=0.684). CONCLUSIONS: Palliative care palliative care consultations facilitate goals discussions, which in turn are associated with reduced rates of 30-day readmissions.
BACKGROUND: Inpatient palliative care consultations have been shown to reduce acute care utilization by reducing length of stay, but less is known about their impact on subsequent costs including hospital readmissions. OBJECTIVE: The study's objective was to examine the impact of inpatient palliative care consultations on 30-day hospital readmissions to a large urban academic medical center. METHODS: The hospital's electronic medical record system was used to identify all live discharges between August 2013 and November 2014. After adjusting for a propensity score, readmission rates were compared between palliative care and usual care groups. RESULTS: Of the 34,541 hospitalizations included in the study, 1430 (4.1%) involved a palliative care consult. After adjusting for the propensity score, patients seen by palliative care had a lower 30-day readmission rate-adjusted odds ratio (AOR) 0.66, 0.55-0.78; p<0.001. Adjusted rates were 10.3% (95% confidence interval [CI] 8.9%-12.0%) for palliative care and 15.0% (95% CI 14.4%-15.4%) for usual care. Among all palliative care patients, consultations that involved goals of care discussions were associated with a lower readmission rate (AOR 0.36, 0.27-0.48; p<0.001), but consultations involving symptom management were not (AOR 1.05, 0.82-1.35; p=0.684). CONCLUSIONS: Palliative care palliative care consultations facilitate goals discussions, which in turn are associated with reduced rates of 30-day readmissions.
Authors: Lisa D DiMartino; Bryan J Weiner; Laura C Hanson; Morris Weinberger; Sarah A Birken; Katherine Reeder-Hayes; Justin G Trogdon Journal: J Palliat Med Date: 2017-08-03 Impact factor: 2.947
Authors: Lauren T Starr; Connie M Ulrich; Scott M Appel; Paul Junker; Nina R O'Connor; Salimah H Meghani Journal: J Palliat Med Date: 2020-04-27 Impact factor: 2.947
Authors: Jasmohan S Bajaj; K Rajender Reddy; Puneeta Tandon; Florence Wong; Patrick S Kamath; Guadalupe Garcia-Tsao; Benedict Maliakkal; Scott W Biggins; Paul J Thuluvath; Michael B Fallon; Ram M Subramanian; Hugo Vargas; Leroy R Thacker; Jacqueline G O'Leary Journal: Hepatology Date: 2016-02-19 Impact factor: 17.425
Authors: Alexis Chettiar; Maria Montez-Rath; Sai Liu; Yoshio N Hall; Ann M O'Hare; Manjula Kurella Tamura Journal: Clin J Am Soc Nephrol Date: 2018-07-19 Impact factor: 8.237
Authors: Katherine R Courtright; Corey Chivers; Michael Becker; Susan H Regli; Linnea C Pepper; Michael E Draugelis; Nina R O'Connor Journal: J Gen Intern Med Date: 2019-07-16 Impact factor: 5.128
Authors: Catherine Saiki; Betty Ferrell; Denise Longo-Schoeberlein; Vincent Chung; Thomas J Smith Journal: J Community Support Oncol Date: 2017 Jul-Aug
Authors: Joseph G Ouslander; Ilkin Naharci; Gabriella Engstrom; Jill Shutes; David G Wolf; Maria Rojido; Ruth Tappen; David Newman Journal: J Am Med Dir Assoc Date: 2016-06-24 Impact factor: 4.669