title: The benefits of a hospital-based inpatient palliative care consultation service: preliminary outcome data.
abstract: This report describes the multiple complementary analytic methods used to create a composite evaluation of the benefits of a hospital-based inpatient palliative care consultation service at Montefiore Medical Center in its preliminary phase. We evaluated data regarding 592 consecutive patients consulted by the palliative care service between November 2000, through March 2002. Standardized medical record reviews indicated that over 90% of interventions recommended by the palliative care team were accepted and acted on by the primary team; audit of the medical records of 368 patients confirmed that pain and other symptoms improved in 87% of patients after palliative care intervention. Ninety-five percent of respondents to a telephone survey of family caregivers described themselves as likely to recommend the service to others. High levels of referring provider satisfaction were evidenced by a Likert- scale provider satisfaction survey and an increase in the rate of referral for palliative care consultation from 2% to 21% of all patients dying at our medical center during the study period. There were also significant reductions in charges for ancillary tests and ventilator charges after palliative care consultation. A matched case control study of mechanically ventilated patients demonstrated significant savings in hospital charges (n = 160 pairs). Length of stay was significantly reduced for patients referred for hospice (n = 112). This type of multifaceted approach is necessary for the evaluation of a service with multiple components that would be difficult to capture with a single analytic approach. This report suggests efficacy of our palliative care service in terms of patient outcomes, provider satisfaction, caregiver satisfaction, and cost savings.
authors.affiliation: Palliative Care Service, Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA. somahony@montefiore.org
authors.forename: Sean
authors.initials: S
authors.lastname: O'Mahony
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Blank
authors.forename: Leah
authors.initials: L
authors.lastname: Zallman
authors.forename: Peter A
authors.initials: PA
authors.lastname: Selwyn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003258:Consumer Behavior; D003284:Contract Services; D003362:Cost-Benefit Analysis; D005260:Female; D017722:Hospital Charges; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000458:organization & administration*; D012017:Referral and Consultation; D012121:Respiration, Artificial / Q000191:economics