Natalie C Ernecoff1, Andrew Bilderback2, Johanna Bellon2, Robert M Arnold1,3, Michael Boninger4,5, Dio Kavalieratos6. 1. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 2. Wolff Center, UPMC, Pittsburgh, Pennsylvania, USA. 3. Palliative and Supportive Institutive, UPMC, Pittsburgh, Pennsylvania, USA. 4. Innovative Homecare Solutions, UPMC, Pittsburgh, Pennsylvania, USA. 5. Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 6. Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Abstract
Background: Specialty palliative care (SPC) provides patient-centered care to people with serious illness and may reduce costs. Specific cost-saving functions of SPC remain unclear. Objectives: (1) To assess the effect of SPC on inpatient costs and length of stay (LOS) and (2) to evaluate differences in costs by indication and timing of SPC. Design: Case-control with in patients who received an SPC consultation and propensity matched controls. Setting: One large U.S. integrated delivery finance system. Measurements: Using administrative data, we assessed costs associated with inpatient stays, a subset of whom received an SPC consultation. Consultations were stratified by reasons based on physician discretion: goals of care, pain management, hospice evaluation, nonpain symptom management, or support. The primary outcome was total operating costs and the secondary outcome was hospital LOS. Results: In total, 1404 patients with SPC consultations associated with unique hospital encounters were matched with 2806 controls. Total operating costs were lower for patients who received an SPC consultation when the consultation was within 0 to 1 days of admission ($6,924 vs. $7,635, p = 0.002). Likewise, LOS was shorter (4.3 vs. 4.7 days, p < 0.001). Upon stratification by reason, goals-of-care consultations early in the hospital stay (days 0-1) were associated with reduced total operating costs ($7,205 vs. $8,677, p < 0.001). Costs were higher for pain management consultations ($7,727 vs. $6,914, p = 0.047). Consultation for hospice evaluation was associated with lower costs, particularly when early (hospital days 0-1: $4,125 vs. $7,415, p < 0.001). Conclusions: SPC was associated with significant cost saving and decreased LOS when occurring early in a hospitalization and used for goals-of-care and hospice evaluation.
Background: Specialty palliative care (SPC) provides patient-centered care to people with serious illness and may reduce costs. Specific cost-saving functions of SPC remain unclear. Objectives: (1) To assess the effect of SPC on inpatient costs and length of stay (LOS) and (2) to evaluate differences in costs by indication and timing of SPC. Design: Case-control with in patients who received an SPC consultation and propensity matched controls. Setting: One large U.S. integrated delivery finance system. Measurements: Using administrative data, we assessed costs associated with inpatient stays, a subset of whom received an SPC consultation. Consultations were stratified by reasons based on physician discretion: goals of care, pain management, hospice evaluation, nonpain symptom management, or support. The primary outcome was total operating costs and the secondary outcome was hospital LOS. Results: In total, 1404 patients with SPC consultations associated with unique hospital encounters were matched with 2806 controls. Total operating costs were lower for patients who received an SPC consultation when the consultation was within 0 to 1 days of admission ($6,924 vs. $7,635, p = 0.002). Likewise, LOS was shorter (4.3 vs. 4.7 days, p < 0.001). Upon stratification by reason, goals-of-care consultations early in the hospital stay (days 0-1) were associated with reduced total operating costs ($7,205 vs. $8,677, p < 0.001). Costs were higher for pain management consultations ($7,727 vs. $6,914, p = 0.047). Consultation for hospice evaluation was associated with lower costs, particularly when early (hospital days 0-1: $4,125 vs. $7,415, p < 0.001). Conclusions: SPC was associated with significant cost saving and decreased LOS when occurring early in a hospitalization and used for goals-of-care and hospice evaluation.
Authors: Natalie C Ernecoff; Kathryn L Wessell; Laura C Hanson; Christopher M Shea; Stacie B Dusetzina; Morris Weinberger; Antonia V Bennett Journal: J Pain Symptom Manage Date: 2019-12-10 Impact factor: 3.612
Authors: Natalie C Ernecoff; Kathryn L Wessell; Laura C Hanson; Stacie B Dusetzina; Christopher M Shea; Morris Weinberger; Antonia V Bennett Journal: J Gen Intern Med Date: 2019-10-24 Impact factor: 5.128
Authors: Rachel Wells; James Nicholas Dionne-Odom; Andres Azuero; Harleah Buck; Deborah Ejem; Kathryn L Burgio; Macy L Stockdill; Rodney Tucker; Salpy V Pamboukian; Jose Tallaj; Sally Engler; Konda Keebler; Sheri Tims; Raegan Durant; Keith M Swetz; Marie Bakitas Journal: J Pain Symptom Manage Date: 2021-02-05 Impact factor: 5.576