Hospital-based palliative care consultation: effects on hospital cost.
BACKGROUND
Palliative care consultation teams in hospitals are becoming increasingly more common. Palliative care improves the quality of hospital care for patients with advanced disease. Less is known about its effects on hospital costs.


OBJECTIVE
To evaluate the relationship between palliative care consultation and hospital costs in patients with advanced disease.


METHODS
An observational study of 3321 veterans hospitalized with advanced disease between October 1, 2004 and September 30, 2006. The sample includes 606 (18%) veterans who received palliative care and 2715 (82%) who received usual hospital care. October 1, 2004 and September 30, 2006.


METHODS
We studied the costs and intensive care unit (ICU) use of palliative versus usual care for patients in five Veterans Affairs hospitals over a 2-year period. We used an instrumental variable approach to control for unmeasured characteristics that affect both treatment and outcome.


RESULTS
The average daily total direct hospital costs were $464 a day lower for the 606 patients receiving palliative compared to the 2715 receiving usual care (p < 0.001). Palliative care patients were 43.7 percentage points less likely to be admitted to ICU during the hospitalization than usual care patients (p < 0.001).


CONCLUSIONS
Palliative care for patients hospitalized with advanced disease results in lower costs of care and less utilization of intensive care compared to similar patients receiving usual care. Selection on unobserved characteristics plays an important role in the determination of costs of care.
Penrod
Joan D
JD
Health Services REAP/GRECC, James J. Peters VA Medical Center, Bronx, NY 10468, USA. joan.penrod@mssm.edu
Deb
Partha
P
Dellenbaugh
Cornelia
C
Burgess
James F
JF
Zhu
Carolyn W
CW
Christiansen
Cindy L
CL
Luhrs
Carol A
CA
Cortez
Therese
T
Livote
Elayne
E
Allen
Veleka
V
Morrison
R Sean
RS
D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D016638:Critical Illness / Q000191:economics; D004180:Direct Service Costs / Q000706:statistics & numerical data; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000191:economics*; D010343:Patient Admission / Q000191:economics; D012017:Referral and Consultation / Q000191:economics*; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States