The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach.
BACKGROUND
While there has been a rapid increase of inpatient palliative care (PC) programs, the financial and clinical benefits have not been well established.


OBJECTIVE
Determine the effect of an inpatient PC consultation service on costs and clinical outcomes.


METHODS
Multifaceted study included: (1) interrupted time-series design utilizing mean daily costs preintervention and postintervention; (2) matched cohort analysis comparing PC to usual care patients; and (3) analysis of symptom control after consultation.


METHODS
Large private, not-for-profit, academic medical center in San Francisco, California, 2004-2006.


METHODS
Time series analysis included 282 PC patients; matched cohorts included 27 PC with 128 usual care patients; clinical outcome analysis of 48 PC patients.


METHODS
Mean daily patient costs and length of stay (LOS); pain, dyspnea, and secretions assessment scores.


RESULTS
Mean daily costs were reduced 33% (p < 0.01) from preintervention to postintervention period. Mean length of stay (LOS) was reduced 30%. Mean daily costs for PC patients were 14.5% lower compared to usual care patients (p < 0.01). Pain, dyspnea, and secretions scores were reduced by 86%, 64%, and 87%, respectively. Over the study period, time to PC referral as well as overall ALOS were reduced by 50%.


CONCLUSIONS
The large reduction in mean daily costs and LOS resulted in an estimated annual savings of $2.2 million in the study hospital. Our results extend the evidence base of financial and clinical benefits associated with inpatient PC programs. We recommend additional study of best practices for identifying patients and providing consultation services, in addition to progressive management support and reimbursement policy.
Ciemins
Elizabeth L
EL
Sutter Health Institute for Research and Education, San Francisco, California 94611, USA. CieminE@sutterhealth.org
Blum
Linda
L
Nunley
Marsha
M
Lasher
Andrew
A
Newman
Jeffrey M
JM
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017050:Episode of Care; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D012495:San Francisco