title: Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect.
abstract: OBJECTIVE
  Previous studies report that early palliative care is associated with clinical benefits, but there is limited evidence on economic impact. This article addresses the research question: Does timing of palliative care have an impact on its effect on cost?
  
  
  METHODS
  Using a prospective, observational design, clinical and cost data were collected for adult patients with an advanced cancer diagnosis admitted to five US hospitals from 2007 to 2011. The sample for economic evaluation was 969 patients; 256 were seen by a palliative care consultation team, and 713 received usual care only. Subsamples were created according to time to consult after admission. Propensity score weights were calculated, matching the treatment and comparison arms specific to each subsample on observed confounders. Generalized linear models with a γ distribution and a log link were applied to estimate the mean treatment effect on cost within subsamples.
  
  
  RESULTS
  Earlier consultation is associated with a larger effect on total direct cost. Intervention within 6 days is estimated to reduce costs by -$1,312 (95% CI, -$2,568 to -$56; P = .04) compared with no intervention and intervention within 2 days by -$2,280 (95% CI, -$3,438 to -$1,122; P < .001); these reductions are equivalent to a 14% and a 24% reduction, respectively, in cost of hospital stay.
  
  
  CONCLUSIONS
  Earlier palliative care consultation during hospital admission is associated with lower cost of hospital stay for patients admitted with an advanced cancer diagnosis. These findings are consistent with a growing body of research on quality and survival suggesting that early palliative care should be more widely implemented.
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD. mayp2@tcd.ie.
authors.forename: Peter
authors.initials: P
authors.lastname: May
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Garrido
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: J Brian
authors.initials: JB
authors.lastname: Cassel
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Meier
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Lee
authors.initials: L
authors.lastname: Stefanis
authors.affiliation: Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care / Q000191:economics* / Q000379:methods / Q000592:standards; D010348:Patient Care Team / Q000191:economics*; D057216:Propensity Score; D011446:Prospective Studies; D012017:Referral and Consultation; D013997:Time Factors; D014481:United States