Administrative outcomes five years after opening an acute palliative care unit at a comprehensive cancer center.
OBJECTIVE
We examined administrative outcomes after opening an oncology acute palliative care unit (APCU), to determine attainment of administrative targets related to the unit's function of acute palliation.


METHODS
We retrospectively reviewed the administrative database for our APCU for the 5 years following its opening in 2003. Data were abstracted on demographic information, as well as source of admission, primary reason for admission, discharge destination, inpatient death rate, and length of stay. Linear regression and the Cochran-Armitage trend test were used for analysis. In keeping with targets set at the unit's opening, our primary hypotheses were that outpatient admissions, admissions for symptom control, and discharges home would increase over the study period; secondary hypotheses were that length of stay and inpatient death rate would decrease.


RESULTS
There were 1748 admissions during the study period: the median age was 64, 54% were women, and the most common cancer sites were gastrointestinal (24%), lung (20%), and gynecologic (13%). There were significant changes for all primary endpoints: outpatient admissions increased from 47% to 70% (p < 0.0001), admissions for symptom control increased from 42% to 75% (p < 0.0001), and discharges home increased from 18% to 39% (p < 0.0001). The secondary end points of death rate and length of stay decreased from 65% to 40% (p < 0.0001) and 12 to 11 days (p = 0.54), respectively.


CONCLUSIONS
Setting and adhering to administrative targets for an APCU is possible with appropriate admission criteria, adequate community resources, and education of patients, families and health professionals regarding the model of care.
Bryson
John
J
Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Canada.
Coe
Gary
G
Swami
Nadia
N
Murphy-Kane
Patricia
P
Seccareccia
Dori
D
Le
Lisa W
LW
Rodin
Gary
G
Zimmermann
Camilla
C
D002173:Cancer Care Facilities / Q000458:organization & administration*; D003191:Comprehensive Health Care / Q000706:statistics & numerical data*; D005260:Female; D006298:Health Services Administration; D006739:Hospital Administration; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000534:rehabilitation*; D009864:Ontario; D017063:Outcome Assessment, Health Care / Q000592:standards*; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies