A pilot study on patient-related costs and factors associated with the cost of specialist palliative care in the hospital: first steps towards a patient classification system in Germany

Abstract

BackgroundSpecialist palliative care in the hospital addresses a heterogeneous patient population with complex care needs. In Germany, palliative care patients are classified based on their primary diagnosis to determine reimbursement despite findings that other factors describe patient needs better. To facilitate adequate resource allocation in this setting, in Australia and in the UK important steps have been undertaken towards identifying drivers of palliative care resource use and classifying patients accordingly. We aimed to pioneer patient classification based on determinants of resource use relevant to specialist palliative care in Germany first, by calculating the patient-level cost of specialist palliative care from the hospital’s perspective, based on the recorded resource use and, subsequently, by analysing influencing factors.MethodsCross-sectional study of consecutive patients who had an episode of specialist palliative care in Munich University Hospital between 20 June and 4 August, 2016. To accurately reflect personnel intensity of specialist palliative care, aside from administrative data, we recorded actual use of all involved health professionals’ labour time at patient level. Factors influencing episode costs were assessed using generalized linear regression and LASSO variable selection.ResultsThe study included 144 patients. Mean costs of specialist palliative care per palliative care unit episode were 6542€ (median: 5789€, SE: 715€) and 823€ (median: 702€, SE: 31€) per consultation episode. Based on multivariate models that considered both variables recorded at beginning and at the end of episode, we identified factors explaining episode cost including phase of illness, Karnofsky performance score, and type of discharge.ConclusionsThis study is an important step towards patient classification in specialist palliative care in Germany as it provides a feasible patient-level costing method and identifies possible starting points for classification. Application to a larger sample will allow for meaningful classification of palliative patients.

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

“…Organization of further care in terms of support in organizing home or hospice care or transferring patients to PC units was a frequently addressed issue and seems to be more present than in other studies. Explanations are pressure to shorten hospital stays on general wards [41], but also uncertainty and lack of knowledge on how to treat patients who have other needs than the "common" treatment the respective department focuses on.…”

COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use – a protocol for a cross-sectional multi-centre study

“…Subproject 3: Multi-centre costing study based on data of resources from subproject 1 and retrospective data of study centres following predefined criteria. The methodology of collecting data on resource use and cost calculation on patient level were tested and further developed through a feasibility study conducted in the Department of Palliative Medicine at the Munich University Hospital in 2016 [9].…”

“…Cost data will be collected on institutional or department level. Based on relevant international studies [10,24,25] and the study group's preparatory work [9], a template with required information for preparing the cost calculation is sent to participating study centres. Generally, aggregated values at institutional or departmental level are requested, in standardised format for the three care settings.…”

“…Based on the pilot study realised in the Department of Palliative Medicine at the Munich University Hospital [8] and unpublished data from England (Prof. Murtagh, personal communication), about 25 variables are expected for the classification. The aggregated unit for data collection is "episode of care", defined as the time of contact between patient and provider in a setting (e.g., inpatient stay, time at home) [7,9]. There are no established methods to calculate the required sample size for the intended analyses based on Classification and Regression Trees (CART).…”

“…First national data show that the same is valid for the German Health Care context. Studies demonstrate that diagnoses is not an indicator for resource use in Germany and that the German Diagnosis-Related Groups system is inadequate to describe resource needs and associated costs in palliative care [8,9].…”