title: Hospital outcomes for a home-based palliative medicine consulting service.
abstract: BACKGROUND
  There is a growing need for palliative care services located outside of hospitals.
  
  
  OBJECTIVE
  This study's objective was to evaluate a home-based, nonhospice, palliative medicine (PM) consultation practice within a fee-for-service environment.
  
  
  METHODS
  Hospital and emergency department (ED) utilization and cost data obtained from administrative records were analyzed with longitudinal analyses to compare use 18 months before and after service enrollment in a single patient group.
  
  
  METHODS
  Patients (N=369) with advanced complex illness (ACI) referred for home-based palliative consultation participated in the study.
  
  
  METHODS
  Consultation conducted by nurse practitioners included a multidimensional assessment with recommendations to outpatient physicians for symptom management and guidance to patient and family for goals of treatment and advanced care planning (ACP). Nurse practitioners were supported by a collaborating PM physician. Follow-up visits varied by need for symptom management and ACP.
  
  
  RESULTS
  Total hospitalizations, total hospital days, total and variable costs, and probability of a 30-day readmission were significantly reduced in the 18-month period following program enrollment. However, probability of an ED visit was not reduced.
  
  
  CONCLUSIONS
  While requiring replication with rigorous methods, preliminary results suggest a home-based PM practice may reduce hospital utilization for ACI patients.
authors: Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
authors: Lou
authors: L
authors: Lukas
authors: Carol
authors: C
authors: Foltz
authors: Hannah
authors: H
authors: Paxton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010166:Palliative Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies