The Impact of Inpatient Palliative Care Consultations on 30-Day Hospital Readmissions.
BACKGROUND
Inpatient palliative care consultations have been shown to reduce acute care utilization by reducing length of stay, but less is known about their impact on subsequent costs including hospital readmissions.


OBJECTIVE
The study's objective was to examine the impact of inpatient palliative care consultations on 30-day hospital readmissions to a large urban academic medical center.


METHODS
The hospital's electronic medical record system was used to identify all live discharges between August 2013 and November 2014. After adjusting for a propensity score, readmission rates were compared between palliative care and usual care groups.


RESULTS
Of the 34,541 hospitalizations included in the study, 1430 (4.1%) involved a palliative care consult. After adjusting for the propensity score, patients seen by palliative care had a lower 30-day readmission rate-adjusted odds ratio (AOR) 0.66, 0.55-0.78; p<0.001. Adjusted rates were 10.3% (95% confidence interval [CI] 8.9%-12.0%) for palliative care and 15.0% (95% CI 14.4%-15.4%) for usual care. Among all palliative care patients, consultations that involved goals of care discussions were associated with a lower readmission rate (AOR 0.36, 0.27-0.48; p<0.001), but consultations involving symptom management were not (AOR 1.05, 0.82-1.35; p=0.684).


CONCLUSIONS
Palliative care palliative care consultations facilitate goals discussions, which in turn are associated with reduced rates of 30-day readmissions.
1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Nina R
NR
O'Connor
1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Mary E
ME
Moyer
2 Program for Clinical Effectiveness and Quality Improvement, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Maryam
M
Behta
1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
David J
DJ
Casarett
D003363:Cost Control / Q000379:methods; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006786:Hospitals, Urban / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010166:Palliative Care / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D057216:Propensity Score; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data