A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs.
BACKGROUND
Current end-of-life hospital care can be of poor quality and high cost. High volume and/or specialist care, and standardized care with clinical practice guidelines, has improved outcomes and costs in other areas of cancer care.


METHODS
The objective of this study was to measure the impact of the palliative care unit (PCU) on the cost of care. The PCU is a dedicated 11-bed inpatient (PCU) staffed by a high-volume specialist team using standardized care. We compared daily charges and costs of the days prior to PCU transfer to the stay in the PCU, for patients who died in the first 6 months after the PCU opened May 2000. We performed a case-control study by matching 38 PCU patients by diagnosis and age to contemporary patients who died outside the PCU cared for by other medical or surgical teams, to adjust for potential differences in the patients or goals of care.


RESULTS
The unit admitted 237 patients from May to December 2000. Fifty-two percent had cancer followed by vascular events, immunodeficiency, or organ failure. For the 123 patients with both non-PCU and PCU days, daily charges and costs were reduced by 66% overall and 74% in "other" (medications, diagnostics, etc.) after transfer to the PCU (p < 0.0001 for all). Comparing the 38 contemporary control patients who died outside the PCU to similar patients who died in the PCU, daily charges were 59% lower (US dollars 5304 +/- 5850 to US dollars 2172 +/- 2250, p = 0.005), direct costs 56% lower (US dollars 1441 +/- 1438 to US dollars 632 +/- 690, p = 0.004), and total costs 57% lower (US dollars 2538 +/- 2918 to US dollars 1095 +/- 1153, p = 0.009).


CONCLUSIONS
Appropriate standardized care of medically complex terminally ill patients in a high-volume, specialized unit may significantly lower cost. These results should be confirmed in a randomized study but such studies are difficult to perform.
Smith
Thomas J
TJ
Virginia Commonwealth University Massey Cancer Center, and Medical College of Virginia Hospitals, Richmond, Virginia 23298-0230, USA. tsmith@hsu.vcu.edu
Coyne
Patrick
P
Cassel
Brian
B
Penberthy
Lynne
L
Hopson
Alison
A
Hager
Mary Ann
MA
D016022:Case-Control Studies; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008511:Medicine; D010147:Pain Measurement; D010166:Palliative Care / Q000191:economics* / Q000592:standards; D010348:Patient Care Team / Q000191:economics* / Q000592:standards; D011787:Quality of Health Care; D013038:Specialization; D013727:Terminal Care / Q000191:economics* / Q000592:standards