Peter May1, Melissa M Garrido2, Egidio Del Fabbro3, Danielle Noreika3, Charles Normand1, Nevena Skoro4, J Brian Cassel5. 1. Trinity College Dublin, Ireland. 2. James J. Peters VA Medical Center, Bronx, New York, USA; Icahn School of Medicine at Mount Sinai, New York, USA. 3. Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA. 4. Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia, USA. 5. Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA. Electronic address: brian.cassel@vcuhealth.org.
Abstract
CONTEXT: Inpatient palliative care (PC) is associated with reduced costs, but the optimal model for providing inpatient PC is unknown. OBJECTIVES: To estimate the effect of palliative care consultations (PCCs) and care in a palliative care unit (PCU) on cost of care, in comparison with usual care (UC) only and in comparison with each other. METHODS: Retrospective cohort study, using multinomial propensity scoring to control for observed confounding between treatment groups. Participants were adults admitted as inpatients between 2009 and 2015, with at least one of seven life-limiting conditions who died within a year of admission (N = 6761). RESULTS: PC within 10 days of admission is estimated to reduce costs compared with UC in the case of both PCU (-$6333; 95% CI: -7871 to -4795; P < 0.001) and PCC (-$3559; 95% CI: -5732 to -1387; P < 0.001). PCU is estimated to reduce costs compared with PCC (-$2774; 95% CI: -5107 to -441; P = 0.02) and length of stay compared with UC (-1.5 days; -2.2 to -0.9; P < 0.001). The comparatively larger effect of PCU over PCC is not observable when the treatment groups are restricted to those who received PC early in their admission (within six days). CONCLUSION: Both PCU and PCC are associated with lower hospital costs than UC. PCU is associated with a greater cost-avoidance effect than PCC, except where both interventions are provided early in the hospitalization. Both timely provision of PC for appropriate patients and creation of more PCUs may decrease hospital costs.
CONTEXT: Inpatient palliative care (PC) is associated with reduced costs, but the optimal model for providing inpatient PC is unknown. OBJECTIVES: To estimate the effect of palliative care consultations (PCCs) and care in a palliative care unit (PCU) on cost of care, in comparison with usual care (UC) only and in comparison with each other. METHODS: Retrospective cohort study, using multinomial propensity scoring to control for observed confounding between treatment groups. Participants were adults admitted as inpatients between 2009 and 2015, with at least one of seven life-limiting conditions who died within a year of admission (N = 6761). RESULTS:PC within 10 days of admission is estimated to reduce costs compared with UC in the case of both PCU (-$6333; 95% CI: -7871 to -4795; P < 0.001) and PCC (-$3559; 95% CI: -5732 to -1387; P < 0.001). PCU is estimated to reduce costs compared with PCC (-$2774; 95% CI: -5107 to -441; P = 0.02) and length of stay compared with UC (-1.5 days; -2.2 to -0.9; P < 0.001). The comparatively larger effect of PCU over PCC is not observable when the treatment groups are restricted to those who received PC early in their admission (within six days). CONCLUSION: Both PCU and PCC are associated with lower hospital costs than UC. PCU is associated with a greater cost-avoidance effect than PCC, except where both interventions are provided early in the hospitalization. Both timely provision of PC for appropriate patients and creation of more PCUs may decrease hospital costs.
Authors: Peter May; Charles Normand; J Brian Cassel; Egidio Del Fabbro; Robert L Fine; Reagan Menz; Corey A Morrison; Joan D Penrod; Chessie Robinson; R Sean Morrison Journal: JAMA Intern Med Date: 2018-06-01 Impact factor: 21.873
Authors: Peter May; Melissa M Garrido; Egidio Del Fabbro; Danielle Noreika; Charles Normand; Nevena Skoro; J Brian Cassel Journal: Med Care Res Rev Date: 2019-01-18 Impact factor: 2.971
Authors: Arianne Brinkman-Stoppelenburg; Suzanne Polinder; Branko F Olij; Barbara van den Berg; Nicolette Gunnink; Mathijs P Hendriks; Yvette M van der Linden; Daan Nieboer; Annemieke van der Padt-Pruijsten; Liesbeth A Peters; Brenda Roggeveen; Frederiek Terheggen; Sylvia Verhage; Maurice J van der Vorst; Ingrid Willemen; Yvonne Vergouwe; Agnes van der Heide Journal: Eur J Cancer Care (Engl) Date: 2019-12-11 Impact factor: 2.520