Sanders Chang1, Peter May2, Nathan E Goldstein3, Juan Wisnivesky4, Doran Ricks5, David Fuld6, Melissa Aldridge3, Kenneth Rosenzweig7, Rolfe Sean Morrison3, Kavita V Dharmarajan8. 1. Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA. 2. Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA; Centre for Health Policy and Management, Trinity College, Dublin, Ireland. 3. Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai Hospital, New York, New York, USA. 4. Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA; Department of Internal Medicine, Mount Sinai Hospital, New York, New York, USA. 5. Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA; Department of Strategic Planning, Mount Sinai Health System, New York, New York, USA. 6. Department of Finance, Mount Sinai Health System, New York, New York, USA. 7. Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA; Department of Radiation Oncology, Mount Sinai Hospital, New York, New York, USA. 8. Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai Hospital, New York, New York, USA; Department of Radiation Oncology, Mount Sinai Hospital, New York, New York, USA. Electronic address: kavita.dharmarajan@mountsinai.org.
Abstract
CONTEXT: Palliative radiation therapy (PRT) is a highly effective treatment in alleviating symptoms from bone metastases; however, currently used standard fractionation schedules can lead to costly care, especially when patients are treated in an inpatient setting. The Palliative Radiation Oncology Consult (PROC) service was developed in 2013 to improve appropriateness, timeliness, and care value from PRT. OBJECTIVES: Our primary objective was to compare total costs among two cohorts of inpatients with bone metastases treated with PRT before, or after, PROC establishment. Secondarily, we evaluated drivers of cost savings including hospital length of stay, utilization of specialty-care palliative services, and PRT schedules. METHODS: Patients were included in our observational cohort study if they received PRT for bone metastases at a single tertiary care hospital from 2010 to 2016. We compared total costs and length of stay using propensity score-adjusted analyses. Palliative care utilization and PRT schedules were compared by χ2 and Mann-Whitney U tests. RESULTS: We identified 181 inpatients, 76 treated before and 105 treated after PROC. Median total hospitalization cost was $76,792 (range $6380-$346,296) for patients treated before PROC and $50,582 (range $7585-$620,943) for patients treated after PROC. This amounted to an average savings of $20,719 in total hospitalization costs (95% CI [$3687, $37,750]). In addition, PROC was associated with shorter PRT schedules, increased palliative care utilization, and an 8.5 days reduction in hospital stay (95% CI [3.2,14]). CONCLUSION: The PROC service, a radiation oncology model integrating palliative care practice, was associated with cost-savings, shorter treatment courses and hospitalizations, and increased palliative care.
CONTEXT: Palliative radiation therapy (PRT) is a highly effective treatment in alleviating symptoms from bone metastases; however, currently used standard fractionation schedules can lead to costly care, especially when patients are treated in an inpatient setting. The Palliative Radiation Oncology Consult (PROC) service was developed in 2013 to improve appropriateness, timeliness, and care value from PRT. OBJECTIVES: Our primary objective was to compare total costs among two cohorts of inpatients with bone metastases treated with PRT before, or after, PROC establishment. Secondarily, we evaluated drivers of cost savings including hospital length of stay, utilization of specialty-care palliative services, and PRT schedules. METHODS:Patients were included in our observational cohort study if they received PRT for bone metastases at a single tertiary care hospital from 2010 to 2016. We compared total costs and length of stay using propensity score-adjusted analyses. Palliative care utilization and PRT schedules were compared by χ2 and Mann-Whitney U tests. RESULTS: We identified 181 inpatients, 76 treated before and 105 treated after PROC. Median total hospitalization cost was $76,792 (range $6380-$346,296) for patients treated before PROC and $50,582 (range $7585-$620,943) for patients treated after PROC. This amounted to an average savings of $20,719 in total hospitalization costs (95% CI [$3687, $37,750]). In addition, PROC was associated with shorter PRT schedules, increased palliative care utilization, and an 8.5 days reduction in hospital stay (95% CI [3.2,14]). CONCLUSION: The PROC service, a radiation oncology model integrating palliative care practice, was associated with cost-savings, shorter treatment courses and hospitalizations, and increased palliative care.
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