title: Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes.
abstract: OBJECTIVE
  Inpatient palliative care units are unavailable in most cancer centers and tertiary hospitals. The purpose of this article is to review the outcomes of the first 344 admissions to the Palliative Care Inpatient Service (PCIS) at our comprehensive cancer center.
  
  
  METHODS
  We retrospectively reviewed our computerized database for clinical and demographic information, length of stay, and hospital billing during the first year of the service's operation.
  
  
  RESULTS
  Three hundred twenty patients were admitted during the study period. Their median age was 57 years. The main cancer diagnoses were thoracic or head and neck (44%), gastrointestinal (25%), and hematologic malignancy (8%). The main referral symptoms were pain (44%), nausea (41%), fatigue (39%), and dyspnea (38%). The median length of stay in the PCIS was 7 days (range, 1 to 58 days). Fifty-nine patients died while in the PCIS. However, the overall hospital mortality rate was not increased compared with that in the year before the establishment of the PCIS (3.58% v 3.59%). The mean reimbursement rate for all palliative care charges was approximately 57%, and the mean daily charges in the PCIS were 38% lower than the mean daily charges for the rest of the hospital. Symptom intensity data showed severe distress on admission and significant improvement in the main target symptoms. Most patients were discharged to a hospice.
  
  
  CONCLUSIONS
  The PCIS has been accepted in our tertiary cancer center on the basis of its clinical utility and financial viability.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA. aelsayem@mdanderson.org
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elsayem
authors.forename: Kay
authors.initials: K
authors.lastname: Swint
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisch
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Suresh
authors.initials: S
authors.lastname: Reddy
authors.forename: Paul
authors.initials: P
authors.lastname: Walker
authors.forename: Donna
authors.initials: D
authors.lastname: Zhukovsky
authors.forename: Patti
authors.initials: P
authors.lastname: Knight
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013781:Texas