Sarina R Isenberg1,2,3,4, Christopher Meaney5, Peter May6,7, Peter Tanuseputro8,9,10, Kieran Quinn11,12,13, Danial Qureshi8,10, Stephanie Saunders14, Colleen Webber8,10, Hsien Seow15, James Downar8,9, Thomas J Smith16,17, Amna Husain5,14, Peter G Lawlor8,9,10, Rob Fowler11,18,19, Julie Lachance20, Kimberlyn McGrail21, Amy T Hsu8,10. 1. Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada. sisenberg@bruyere.org. 2. Department of Family and Community Medicine, University of Toronto, Toronto, Canada. sisenberg@bruyere.org. 3. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. sisenberg@bruyere.org. 4. Department of Medicine, University of Ottawa, Ottawa, Canada. sisenberg@bruyere.org. 5. Department of Family and Community Medicine, University of Toronto, Toronto, Canada. 6. Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland. 7. The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland. 8. Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada. 9. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada. 10. Ottawa Hospital Research Institute, Ottawa, Canada. 11. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 12. Department of Medicine, University of Toronto, Toronto, Canada. 13. Department of Medicine, Division of Internal Medicine, Sinai Health, Toronto, Canada. 14. Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada. 15. Department of Oncology, McMaster University, Hamilton, Canada. 16. Department of Medicine, Johns Hopkins Hospital and Health System, Baltimore, USA. 17. Department of Oncology, Johns Hopkins Hospital and Health System, Baltimore, USA. 18. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. 19. Tory Trauma Program, Sunnybrook Hospital, Toronto, Canada. 20. End-of-Life Care Unit, Strategic Policy Branch, Health Canada, Ottawa, Canada. 21. Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
Abstract
BACKGROUND: Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients' receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. METHODS: Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. RESULTS: There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). CONCLUSIONS: Increased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.
BACKGROUND: Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients' receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. METHODS: Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. RESULTS: There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). CONCLUSIONS: Increased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.
Entities:
Keywords:
Acute care costs; End of life; Palliative care; Terminal hospitalizations
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