In the Journals

In-hospital palliative care provided cost savings to hospitals, patients

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August 4, 2014

The implementation of a hospital-based palliative care program confers financial benefits to institutions and patients, particularly in cases of in-hospital mortality, according to recent findings.

“Palliative care programs are increasingly prevalent in US hospitals, but the financial incentives for hospitals to deploy them are not well understood,” Ian M. McCarthy, PhD, assistant professor of economics at Emory University, said in a press release. “Palliative care programs have proven highly effective at addressing a wide range of needs felt by patients and their families.”

Researchers compiled data from all stays between 2009 and June 2012 at five hospital campuses with in-hospital palliative care programs. The hospitals were located in the Dallas/Fort Worth area, and eligible patients included adults who stayed at the hospital between 7 and 30 days. The researchers defined a palliative care consult as a formal in-hospital appointment with a member of a given hospital’s palliative care team.

McCarthy and colleagues used propensity score methods to match palliative care patients to those who did not have a palliative care consult. In addition, the researchers estimated direct cost to the matched groups using weighted generalized linear models, which analyzed direct cost in terms of age, payer type, diagnosis, race, sex, Charlson comorbidity index, hospital and an indicator for whether the patient underwent a palliative care consult.

After applying exclusion restrictions, the researchers identified 38,465 consecutive inpatient stays encompassing 2,392 palliative care patients (1,819 were discharged alive and 573 died in the hospital).

The investigators found that the overall cost reduction from palliative care was $3,426 per patient for those who died in the hospital. Although no significant savings were observed in the patients who were discharged alive, this lack of savings was thought to be specific to certain hospitals, patients with a pulmonary or infection diagnosis, and patients with a palliative care consult after 10 days in the hospital.

Palliative care consults were found to lower costs for patients with a primary diagnosis of cancer, both in cases of in-hospital mortality and survival at discharge. Savings were highest in patients discharged alive when the palliative care team included substantial involvement by physicians and registered nurses.

“We find that a palliative care program offers a financial benefit via cost reduction for institutions willing to invest in such programs, even in a market and in hospitals that already have high hospice utilization,” McCarthy and colleagues wrote. “The greatest financial benefit was derived from those patients who died in the hospital, particularly for those with a palliative care consultation within 15 days of admission.”

Disclosure: The researchers report no relevant financial disclosures.

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