Nita Khandelwal1, David C Benkeser, Norma B Coe, J Randall Curtis. 1. 1Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, WA. 2Department of Biostatistics, University of Washington, Seattle, WA. 3Department of Health Services, University of Washington, Seattle, WA. 4Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA.
Abstract
OBJECTIVES: To estimate the potential ICU-related cost savings if in-hospital advance care planning and ICU-based palliative care consultation became standard of care for patients with chronic and serious illness. DESIGN AND SETTING: Decision analysis using literature estimates and inpatient administrative data from Premier. PATIENTS: Patients with chronic, life-limiting illness admitted to a hospital within the Premier network. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using Premier data (2008-2012), ICU resource utilization and costs were tracked over a 1-year time horizon for 2,097,563 patients with chronic life-limiting illness. Using a Markov microsimulation model, we explored the potential cost savings from the hospital system perspective under a variety of scenarios by varying the interventions' efficacies and availabilities. Of 2,097,563 patients, 657,825 (31%) used the ICU during the 1-year time horizon; mean ICU spending per patient was 11.3k (SD, 17.6k). In the base-case analysis, if in-hospital advance care planning and ICU-based palliative care consultation were systematically provided, we estimated a mean reduction in ICU costs of 2.8k (SD, 14.5k) per patient and an ICU cost saving of 25%. Among the simulated patients who used the ICU, the receipt of both interventions could have resulted in ICU cost savings of 1.9 billion, representing a 6% reduction in total hospital costs for these patients. CONCLUSIONS: In-hospital advance care planning and palliative care consultation have the potential to result in significant cost savings. Studies are needed to confirm these findings, but our results provide guidance for hospitals and policymakers.
OBJECTIVES: To estimate the potential ICU-related cost savings if in-hospital advance care planning and ICU-based palliative care consultation became standard of care for patients with chronic and serious illness. DESIGN AND SETTING: Decision analysis using literature estimates and inpatient administrative data from Premier. PATIENTS: Patients with chronic, life-limiting illness admitted to a hospital within the Premier network. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using Premier data (2008-2012), ICU resource utilization and costs were tracked over a 1-year time horizon for 2,097,563 patients with chronic life-limiting illness. Using a Markov microsimulation model, we explored the potential cost savings from the hospital system perspective under a variety of scenarios by varying the interventions' efficacies and availabilities. Of 2,097,563 patients, 657,825 (31%) used the ICU during the 1-year time horizon; mean ICU spending per patient was 11.3k (SD, 17.6k). In the base-case analysis, if in-hospital advance care planning and ICU-based palliative care consultation were systematically provided, we estimated a mean reduction in ICU costs of 2.8k (SD, 14.5k) per patient and an ICU cost saving of 25%. Among the simulated patients who used the ICU, the receipt of both interventions could have resulted in ICU cost savings of 1.9 billion, representing a 6% reduction in total hospital costs for these patients. CONCLUSIONS: In-hospital advance care planning and palliative care consultation have the potential to result in significant cost savings. Studies are needed to confirm these findings, but our results provide guidance for hospitals and policymakers.
Authors: J Randall Curtis; Elizabeth L Nielsen; Patsy D Treece; Lois Downey; Danae Dotolo; Sarah E Shannon; Anthony L Back; Gordon D Rubenfeld; Ruth A Engelberg Journal: Am J Respir Crit Care Med Date: 2010-09-10 Impact factor: 21.405
Authors: Glenn Gade; Ingrid Venohr; Douglas Conner; Kathleen McGrady; Jeffrey Beane; Robert H Richardson; Marilyn P Williams; Marcia Liberson; Mark Blum; Richard Della Penna Journal: J Palliat Med Date: 2008-03 Impact factor: 2.947
Authors: Lawrence J Schneiderman; Todd Gilmer; Holly D Teetzel; Daniel O Dugan; Jeffrey Blustein; Ronald Cranford; Kathleen B Briggs; Glen I Komatsu; Paula Goodman-Crews; Felicia Cohn; Ernlé W D Young Journal: JAMA Date: 2003-09-03 Impact factor: 56.272
Authors: Kei Ouchi; Naomi George; Jeremiah D Schuur; Emily L Aaronson; Charlotta Lindvall; Edward Bernstein; Rebecca L Sudore; Mara A Schonberg; Susan D Block; James A Tulsky Journal: Ann Emerg Med Date: 2019-02-13 Impact factor: 5.721
Authors: Nita Khandelwal; David Benkeser; Norma B Coe; Ruth A Engelberg; Joan M Teno; J Randall Curtis Journal: J Palliat Med Date: 2016-07-20 Impact factor: 2.947
Authors: Christopher E Cox; Deepshikha Charan Ashana; Nita Khandelwal; Arif H Kamal; Ruth A Engelberg Journal: J Pain Symptom Manage Date: 2022-06 Impact factor: 5.576
Authors: Lauren T Starr; Connie M Ulrich; Paul Junker; Liming Huang; Nina R O'Connor; Salimah H Meghani Journal: Am J Hosp Palliat Care Date: 2020-06-30 Impact factor: 2.500
Authors: João Gabriel Rosa Ramos; Fernanda Correia Tourinho; Patrícia Borrione; Paula Azi; Tuanny Andrade; Vanessa Costa; Zan Reis; Paulo Benigno Pena Batista; Ana Verena Mendes Journal: Rev Bras Ter Intensiva Date: 2018-09-03
Authors: Mohammad Adrian Hasdianda; Tamryn F Gray; Josephine Lo Bello; Brittany Ballaron; Natasha A Egorova; Donna L Berry; Kei Ouchi Journal: Palliat Med Rep Date: 2021-03-12
Authors: David B Simmons; Benjamin H Levi; Michael J Green; In Seo La; Daniella Lipnick; Theresa J Smith; Elizabeth R Thiede; Debra L Wiegand; Lauren Van Scoy Journal: Am J Hosp Palliat Care Date: 2021-06-24 Impact factor: 2.090