Overview: Over the past five years the number of inpatient palliative care teams (PCTs) has grown drastically in the United States. However, 70% of U.S. hospitals continue to provide end-of-life healthcare services in the absence of a PCT. While studies have shown that PCTs contribute to improved quality of life, patient satisfaction, and short-term utilization and costs, few have examined whether these consultations have long-term effects.
Methods: This study utilized a matched cohort design to examine mortality, cost, and utilization up to one year after an initial PCT consultation. Patients admitted to a large non-profit hospital between June 2004 and December 2007 were included. Patients seen by the PCT during that time were matched to 'usual care' patients based on age, risk of mortality, prior year hospitalized days, and disease. Utilization and cost measures were abstracted from hospital administrative claims and cost accounting data; mortality data were collected from the social security death index. Analyses were performed using summary statistics, chi square analysis, regression models, Kaplan-Meier survival analysis, and Cox proportional hazard models.
Results: A total of 361 intervention subjects were matched to a total of 361 usual care subjects. Results revealed patients receiving a PCT consultation were associated with a 2.5 times greater likelihood of dying during the follow-up period, most of which was likely caused by decreased intervention in the first 60 days post consultation. No differences were found in inpatient mortality. Decreases were found in the likelihood of hospitalization at 12 months (OR 0.68, p<.01) and overall length of stay (OR 0.65, p<.05) over the follow-up period when subjects were initially seen by the PCT. Additionally, patients receiving an initial PCT consultation had lower costs to the hospital over the follow-up period ($4433, p<.0001), saving approximately $1.6 million among the study population.
Conclusion: These findings suggest that use of inpatient PCTs decreases hospital utilization and costs of a vulnerable end-of-life population, having no effect on inpatient mortality rates. Therefore, the implementation and maintenance of inpatient PCTs has the possibility to improve hospital net income while also improving the quality of patient care for those at the end-of-life.
