Hospital palliative care consult improves value-based purchasing outcomes in a propensity score–matched cohort

Abstract

Background: Hospital-based palliative care consultation is consistently associated with reduced hospitalization costs and more importantly with improved patient quality of life. As healthcare systems move toward value-based purchasing rather than fee-for-service models, understanding how palliative care consultation is associated with value-based purchasing metrics can provide evidence for expanded health system support for a greater palliative care presence. Aim: To understand how a palliative care consultation impacts rates of patient readmission and hospital-acquired infections associated with value-based purchasing metrics. Design: Retrospective propensity-matched case–control study evaluating the impact of palliative care consultation on hospital charges, hospital and intensive care unit length of stay, readmission rates, and rates of hospital-acquired conditions. Setting/participants: All adult patients admitted to a two hospital healthcare system over a 2-year period from 1 April 2015 to 31 March 2017. The palliative care team involved three physicians, five advanced practice providers, a social worker, and a chaplain during the study period. Results: A total of 3415 patients receiving a palliative consult were propensity matched to 25,028 controls. Compared to controls, cases had decreased charges per day and decreased rates of 7-, 30-, and 90-day readmissions. Conclusion: Through value-based purchasing, hospitals have 3% of their Medicare reimbursements at risk based on readmission rates. By clarifying prognosis and patient goals, palliative care consultation reduces readmission rates. Hospital systems may want to invest in larger palliative care programs as part of their efforts to reduce hospital readmissions.

Impacto econômico da atuação de equipes consultoras de Cuidados Paliativos inseridas em hospital

“…Categoria 1: Nesta categoria estão estudos em que o impacto econômico das intervenções de equipes consultoras de Cuidados Paliativos significa redução de custos oriunda de menores taxas de readmissão hospitalar, menor tempo médio de permanência, menor número de procedimentos diagnósticos e terapêuticos e menor número de admissão em UTI (3 artigos) 13,16,17 ;…”

“…Os demais artigos foram observacionais, dessa forma, uma relação de causa e efeito não pode ser definida. No entanto, há resultados que sugerem que o recebimento de Cuidados Paliativos por equipes consultoras está associado à menor tempo de permanência e a menores custos hospitalares totais e diários¹³, considerando que, quando são precoces, reduzem a intensidade do tratamento, no sentido de reduzirem a indicação de tratamentos fúteis e exames desnecessários 14,16,19 .…”

“…Além disso, também foram descritas evidências que sugerem que ao esclarecer o prognóstico e as metas do tratamento ao paciente, o atendimento das equipes consultoras de cuidados paliativos reduz as taxas de readmissão 16 . Os resultados do estudo de O'Mahony S, et al 17 , sugerem ainda que, além do encaminhamento precoce, a busca ativa de pacientes com critérios para Cuidados Paliativos, favorece a economia de custos hospitalares.…”

Early palliative care for solid and blood cancer patients and caregivers: Quantitative and qualitative results of a long-term experience as a case of value-based medicine

“…The EPC model of care seems to satisfy at least four of these steps: in order to be called an EPC intervention, it requires that different units of practice are integrated, and it is able to integrate care delivery across separate facilities, for example when transitioning from disease-oriented care to home care ( 33 ) (points 1 and 4); it has also been shown to be a cost-effective model ( 60 – 63 ), although there are still few studies based on sufficiently big samples. Indeed, adopting value-based care supports health care providers in their decisions while focusing on the values of patients, leading to lower healthcare costs, regardless of professionals' concern with the cost of treatment ( 64 ) (point 2). As regards point 6, there is mounting evidence that digital health technology, in the form of platforms allowing the electronic collection of patient reported outcomes (PROs), can have a positive impact on the overall management of cancer patients.…”