Development and Implementation of an Inpatient Acute Palliative Care Service

Santa-Emma, Philip H.; Roach, Ralph W.; Gill, Mary Ann; Spayde, Pam; Taylor, Robert M.

doi:10.1089/10966210252785051

Cited by 43 publications

(21 citation statements)

References 11 publications

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“…This analysis and previous experiences in the USA 6,7,18,28 suggest that the most effective way to improve the care of cancer patients would be to develop formal structures within each oncological department to provide a standardized and integrated approach. Our findings also suggest both a cost and quality incentive for oncological departments to develop APC.…”

Section: Resultsmentioning

confidence: 91%

Clinical and financial analysis of an acute palliative care unit in an oncological department

et al. 2008

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The aim of this article is to describe the clinical activity and medical intervention of an acute model of palliative care unit (APC), as well as the reimbursement procedures and economic viability. A sample of 504 patients admitted at an APC in 1 year was surveyed. Indications for admission, pain and symptom intensity, analgesic treatments, procedures, instrumental examinations and modalities of discharge were recorded. For each patient, tariff for reimbursement was calculated according to the existent disease related grouping (DRG) system. The mean age was 62 years, and 246 patients were males. The mean hospital stay was 5.4 days. Pain control was the most frequent indication for admission. All patients had laboratory tests and several instrumental examinations. Almost all patients were prescribed one or more opioids at significant doses, and different routes of administration, as well as medication as needed. 59 patients received blood cell transfusions and 34 interventional procedures. Only 40 patients died in the unit, 11 of them being sedated at the end of life. Treatment efficacy was considered optimal and mild in 264 and 226 patients respectively. A mean of 3019 euros for admission was reimbursed by the Health Care System. APCs are of paramount importance within an oncological department, as they provide effective and intensive treatments during the entire course of disease, providing a simultaneous and integrated approach. Our findings also suggest both a cost and quality incentive for oncological departments to develop APC.

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Section: Resultsmentioning

confidence: 91%

Clinical and financial analysis of an acute palliative care unit in an oncological department

et al. 2008

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“…[21][22][23][24][25][26] Patients receiving palliative care were identified through administrative databases and billing records. Patients were classified as receiving palliative care if a consultation was requested by the patient's attending physician, the patient was seen and evaluated by the palliative care team for one or more visits, and at least one set of recommendations was made by the palliative care team for the primary team caring for the patient.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

et al. 2011

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Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004-07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. These reductions included $4,098 in hospital costs per admission for patients discharged alive, and $7,563 for patients who died in the hospital. Consistent with the goals of a majority of patients and their families, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than the matched usual care patients. We estimate that the reductions in Medicaid hospital spending in New York State could eventually range from $84 million to $252 million annually (assuming that 2 percent and 6 percent of Medicaid patients discharged from the hospital received palliative care, respectively), if every hospital with 150 or more beds had a fully operational palliative care consultation team.

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“…We identified a cohort of adult patients with chronic life-limiting illness considered to be at high risk of death using criteria that have been previously identified (10, 13, 20, 21) (Table 1). We excluded patients with the DRG (Diagnosis-related group) upcode associated with palliative care (V66.7; 4.3% of patients) and assumed the remaining patients did not receive palliative care interventions.…”

Section: Methodsmentioning

confidence: 99%

Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness*

Khandelwal

Benkeser

Coe

et al. 2016

Critical Care Medicine

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Objective To estimate the potential ICU-related cost-savings if in-hospital advance care planning and ICU-based palliative care consultation became standard of care for patients with chronic and serious illness. Design and Setting Decision analysis using literature estimates and inpatient administrative data from Premier, Inc. Patients Patients with chronic, life-limiting illness admitted to a hospital within the Premier network. Methods Using Premier data (2008-2012), ICU resource utilization and costs were tracked over a 1-year time horizon for 2,097,563 patients with chronic life-limiting illness. Using a Markov microsimulation model, we explored the potential cost-savings from the hospital system perspective under a variety of scenarios by varying the interventions' efficacies and availabilities. Main Results Of 2,097,563 patients, 657, 825 (31%) utilized the ICU during the 1-year time horizon; mean ICU spending per patient was 11.3k (SD 17.6k). In the base-case analysis, if in-hospital advance care planning and ICU-based palliative care consultation were systematically provided, we estimated a mean reduction in ICU costs of 2.8k (SD 14.5k) per patient and an ICU cost-savings of 25%. Among the simulated patients who utilized the ICU, the receipt of both interventions could have resulted in ICU cost savings of 1.9 billion, representing a 6% reduction in total hospital costs for these patients. Conclusions In-hospital advance care planning and palliative care consultation have the potential to result in significant cost-savings. Studies are needed to confirm these findings, but our results provide guidance for hospitals and policy-makers.

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Development and Implementation of an Inpatient Acute Palliative Care Service

Abstract: Mount Carmel Health has developed an APCS and APCU integrated into the mainstream of each of its hospitals, providing an opportunity for a more appropriate focus on end-of-life issues for patients with poor prognoses, intense medical needs, and complex family issues.

Cited by 43 publications

References 11 publications

Clinical and financial analysis of an acute palliative care unit in an oncological department

Clinical and financial analysis of an acute palliative care unit in an oncological department

Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness*

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