title: The role and timing of palliative medicine consultation for women with gynecologic malignancies: association with end of life interventions and direct hospital costs.
abstract: OBJECTIVE
  Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies.
  
  
  METHODS
  A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥ 30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission <3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher's Exact, Mann-Whitney U, Kaplan-Meier, and Student's T testing.
  
  
  RESULTS
  49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0-3) versus 2 (range 0-6) p=0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0-28,019) versus untimely, $7729 (0-52,720), p=0.01.
  
  
  CONCLUSIONS
  Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: nevadunskynicole@yahoo.com.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Nevadunsky
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Gordon
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Spoozak
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Van Arsdale
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Yijuan
authors.initials: Y
authors.lastname: Hou
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Merieme
authors.initials: M
authors.lastname: Klobocista
authors.affiliation: Beth Israel Medical Center, Department of Palliative Medicine, New York, NY, USA.
authors.forename: Serife
authors.initials: S
authors.lastname: Eti
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Rapkin
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology / Q000628:therapy*; D017721:Hospital Costs; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D011788:Quality of Life; D012017:Referral and Consultation; D012189:Retrospective Studies; D013727:Terminal Care; D013997:Time Factors
keywords: Aggressiveness of care; End of life care; Gynecologic malignancies; Hospital costs; Palliative medicine; Quality-of-life