Parag Bharadwaj1,2, Karen M Helfen3, Leo J Deleon4, Douglas M Thompson3, Jennifer R Ward5, John Patterson6, Sriram Yennurajalingam7, Joe B Kim8, Kathie S Zimbro3, J Brian Cassel9, Aaron D Bleznak10. 1. 1 Palliative Care, Sentara Healthcare , Norfolk, Virginia. 2. 2 Department of Internal Medicine, Eastern Virginia Medical School , Norfolk, Virginia. 3. 3 Sentara Healthcare , Norfolk, Virginia. 4. 4 Sentara Princess Anne Hospital , Virginia Beach, Virginia. 5. 5 Sentara Obici Hospital , Suffolk, Virginia. 6. 6 Sentara Leigh Hospital , Norfolk, Virginia. 7. 7 MD Anderson Cancer Center , Houston, Texas. 8. 8 Cedars-Sinai Medical Center , Los Angeles, California. 9. 9 Massey Cancer Center, Virginia Commonwealth University , Richmond, Virginia. 10. 10 Sentara Medical Group , Norfolk, Virginia.
Abstract
BACKGROUND: A recent trend in health care is to integrate palliative care (PC) programs across multiple hospitals to reduce variation, improve quality, and reduce cost. OBJECTIVE: The study objective was to demonstrate the benefits of PC for a system. METHODS: The study was a descriptive study using retrospective medical records in seven federated hospitals where PC developed differently before system integration. Measured were length of stay (LOS), mortality, readmissions, saved intensive care unit (ICU) days, cost avoidance, and hospice referrals. RESULTS: PC services within the first 48 hours of admission demonstrate a shorter LOS (5.08 days), reduced costs 40% ($2,362 per day), and decreased mortality (1.01 versus 1.10) for one hospital. Readmissions at 30, 60, and 90 days after a PC consult decreased (61.5%, 47.0%, and 42.1%, respectively). Annual pre- and postprogram referrals to hospice increased (65 to 107). Using modified matched pairs, LOS of PC patients seen within 48 hours of admission average 1.67 days less compared to non-PC patients. LOS for ICU patients with PC services in the ICU within the first 48 hours decreased by 1.12 days. Overall cost avoidance was 1.5 times total cost for PC programs systemwide. One pilot project using a full-time physician in the ICU reduced cost more than $600,000, with 315 saved ICU days, annualized. Systemwide, 69.3% of all referrals to hospice were made by the PC service. CONCLUSION: Early involvement of PC services emerged as advantageous to the net benefit. Given that health care's changing landscape will increasingly include bundled payment and risk holding strategies to improve quality and reduce cost in health care systems, systemwide PC will play a vital role.
BACKGROUND: A recent trend in health care is to integrate palliative care (PC) programs across multiple hospitals to reduce variation, improve quality, and reduce cost. OBJECTIVE: The study objective was to demonstrate the benefits of PC for a system. METHODS: The study was a descriptive study using retrospective medical records in seven federated hospitals where PC developed differently before system integration. Measured were length of stay (LOS), mortality, readmissions, saved intensive care unit (ICU) days, cost avoidance, and hospice referrals. RESULTS: PC services within the first 48 hours of admission demonstrate a shorter LOS (5.08 days), reduced costs 40% ($2,362 per day), and decreased mortality (1.01 versus 1.10) for one hospital. Readmissions at 30, 60, and 90 days after a PC consult decreased (61.5%, 47.0%, and 42.1%, respectively). Annual pre- and postprogram referrals to hospice increased (65 to 107). Using modified matched pairs, LOS of PC patients seen within 48 hours of admission average 1.67 days less compared to non-PC patients. LOS for ICU patients with PC services in the ICU within the first 48 hours decreased by 1.12 days. Overall cost avoidance was 1.5 times total cost for PC programs systemwide. One pilot project using a full-time physician in the ICU reduced cost more than $600,000, with 315 saved ICU days, annualized. Systemwide, 69.3% of all referrals to hospice were made by the PC service. CONCLUSION: Early involvement of PC services emerged as advantageous to the net benefit. Given that health care's changing landscape will increasingly include bundled payment and risk holding strategies to improve quality and reduce cost in health care systems, systemwide PC will play a vital role.
Authors: Michael Hoerger; Laura M Perry; Brittany D Korotkin; Leah E Walsh; Adina S Kazan; James L Rogers; Wasef Atiya; Sonia Malhotra; James I Gerhart Journal: J Palliat Med Date: 2019-01-07 Impact factor: 2.947
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: Anna Kowalczys; Michał Bohdan; Alina Wilkowska; Iga Pawłowska; Leszek Pawłowski; Piotr Janowiak; Ewa Jassem; Małgorzata Lelonek; Marcin Gruchała; Piotr Sobański Journal: Front Cardiovasc Med Date: 2022-09-27
Authors: Lucy E Ziegler; Cheryl L Craigs; Robert M West; Paul Carder; Adam Hurlow; Pablo Millares-Martin; Geoff Hall; Michael I Bennett Journal: BMJ Open Date: 2018-01-31 Impact factor: 2.692