title: Cost savings vary by length of stay for inpatients receiving palliative care consultation services.
abstract: BACKGROUND
  Cost savings associated with palliative care (PC) consultation have been demonstrated for total hospital costs and daily costs after PC involvement. This analysis adds another approach by examining costs stratified by hospital length of stay (LOS).
  
  
  OBJECTIVE
  To examine cost savings for patients who receive PC consultations during short, medium, and long hospitalizations.
  
  
  METHODS
  Data were analyzed for 1815 PC patients and 1790 comparison patients from two academic medical centers between 2005 and 2008, matched on discharge disposition, LOS category, and propensity for a PC consultation. We used generalized linear models and regression analysis to compare cost differences for LOS of 1 to 7 days (38% of consults), 8 to 30 days (48%), and >30 days (14%). Comparisons were done for all patients in both hospitals (n=3605) and by discharge disposition: survivors (n=2226) and decedents (n=1379); analyses were repeated for each hospital.
  
  
  RESULTS
  Significant savings per admission were associated with shorter LOS: For stays of 1 to 7 days, costs were lower for all PC patients by 13% ($2141), and for survivors by 19.1% ($2946). For stays of 8 to 30 days, costs were lower for all PC patients by 4.9% ($2870), and for survivors by 6% ($2487). Extrapolating the per admission cost across the PC patient groups with lower costs, these programs saved about $1.46 million for LOS under a week and about $2.5 million for LOS of 8 to 30 days. Patients with stays >30 days showed no differences in costs, perhaps due to preferences for more aggressive care for those who stay in the hospital more than a month.
  
  
  CONCLUSIONS
  Cost savings due to PC are realized for short and medium LOS but not stays >30 days. These findings suggest savings can be achieved by earlier involvement of palliative care, and support screening efforts to identify patients who can benefit from PC services early in an admission.
authors.affiliation: 1 Department of Bioethics and Humanities, School of Medicine, University of Washington , Seattle, Washington.
authors.forename: Helene
authors.initials: H
authors.lastname: Starks
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.forename: Stuart
authors.initials: S
authors.lastname: Farber
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Owens
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D017046:Cost Savings; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics*; D057216:Propensity Score; D012017:Referral and Consultation / Q000191:economics*; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors