Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect

May, Peter; Garrido, Melissa M.; Cassel, J. Brian; Kelley, Amy S.; Meier, Diane E.; Normand, Charles; Smith, Thomas J.; Stefanis, Lee; Morrison, R. Sean

doi:10.1200/jco.2014.60.2334

Cited by 227 publications

(227 citation statements)

References 33 publications

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“…Nonetheless, there is compelling evidence that early involvement of palliative care services improves quality of life, patient satisfaction, care giver satisfaction and in some settings can improve overall survival [51][52][53]. Incorporating palliative care into cancer care, particularly early in the patient journey may also offer the possibility of substantial cost-savings [51,54]. Thus, increasing access to palliative care for patients with blood cancers, including those pursuing disease-directed treatment, may offer huge opportunities to improve care while also reducing health care costs.…”

Section: Discussionmentioning

confidence: 99%

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

et al. 2016

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Choosing Wisely (CW) is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. In an effort to learn from and leverage the work of others, the American Society of Hematology CW Task Force developed a method to identify and prioritize CW recommendations from other medical societies of high relevance and importance to patients with blood disorders and their physicians. All 380 CW recommendations were reviewed and assessed for relevance and importance. Relevance was assessed using the MORE TM relevance scale. Importance was assessed with regard to six guiding principles: harm avoidance, evidence, aggregate cost, relevance, frequency and impact. Harm avoidance was considered the most important principle. Ten highly relevant and important recommendations were identified from a variety of professional societies. Recommendations focused on decreasing unnecessary imaging, blood work, treatments and transfusions, as well as on increasing collaboration across disciplines and considering value when recommending treatments. Many CW recommendations have relevance beyond the society of origin. The methods developed by the ASH CW Task Force could be easily adapted by other Societies to identify additional CW recommendations of relevance and importance to their fields.

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Section: Discussionmentioning

confidence: 99%

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

et al. 2016

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“…Randomized studies of palliative care interventions have shown improved quality of life and greater patient satisfaction, while potentially reducing costs through reductions in aggressive treatment strategies [55,56]. As such, the increased use of palliative care within ACOs would potentially improve VBC while incorporating patient-centered values [57,58].…”

Section: Innovative Models Of Carementioning

confidence: 99%

Value Based Care and Patient-Centered Care: Divergent or Complementary?

Tseng

Hicks

2016

Curr Hematol Malig Rep

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Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

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“…20 Bundled payment reimbursement could increase the use of palliative care because of its demonstrated cost savings. [7][8][9][10][11][12][13][14] CMS and private insurers should also explore reimbursing providers for telehealth consultations, which could facilitate access to specialty-level palliative care in programs that do not have physicians and in rural and other safetynet settings. 32,33 Health system managers have a responsibility to ensure that palliative care is available and of high quality.…”

Section: Discussionmentioning

confidence: 99%

“…1,6 Growth in palliative care programs has been driven in part by evidence that palliative care improves patient outcomes and satisfaction, while reducing costs associated with intensive medical care. 1,[7][8][9][10][11][12][13][14] Palliative care can be provided in settings throughout the continuum of care, but the predominant model in the United States (outside of hospice care) is the hospital consultative team model. 3 Central to this model are interprofessional teams, which can include physicians, advanced practice and other registered nurses, social workers, chaplains, pharmacists, rehabilitation therapists, direct care workers, and other clinical and nonclinical specialists.…”

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confidence: 99%

Few Hospital Palliative Care Programs Meet National Staffing Recommendations

et al. 2016

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The predominant model for palliative care delivery, outside of hospice care, is the hospital-based consultative team. Although a majority of US hospitals offer palliative care services, there has been little research on the staffing of their program teams and whether those teams meet national guidelines, such as the Joint Commission's standard of including at least one physician, an advanced practice or other registered nurse, a social worker, and a chaplain. Data from the 2012-13 annual surveys of the National Palliative Care Registry indicate that only 25 percent of participating programs met that standard based on funded positions, and even when unfunded positions were included, only 39 percent of programs met the standard. Larger palliative care programs were more likely than smaller ones to include a funded physician position, while smaller programs were more reliant upon advanced practice and registered nurses. To meet current and future palliative care needs, expanded and enhanced education, as well as supportive financing mechanisms for consultations, are needed.

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Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect

Cited by 227 publications

References 33 publications

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

Value Based Care and Patient-Centered Care: Divergent or Complementary?

Few Hospital Palliative Care Programs Meet National Staffing Recommendations

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