title: Making the Case for Palliative Care at the System Level: Outcomes Data.
abstract: BACKGROUND
  A recent trend in health care is to integrate palliative care (PC) programs across multiple hospitals to reduce variation, improve quality, and reduce cost.
  
  
  OBJECTIVE
  The study objective was to demonstrate the benefits of PC for a system.
  
  
  METHODS
  The study was a descriptive study using retrospective medical records in seven federated hospitals where PC developed differently before system integration. Measured were length of stay (LOS), mortality, readmissions, saved intensive care unit (ICU) days, cost avoidance, and hospice referrals.
  
  
  RESULTS
  PC services within the first 48 hours of admission demonstrate a shorter LOS (5.08 days), reduced costs 40% ($2,362 per day), and decreased mortality (1.01 versus 1.10) for one hospital. Readmissions at 30, 60, and 90 days after a PC consult decreased (61.5%, 47.0%, and 42.1%, respectively). Annual pre- and postprogram referrals to hospice increased (65 to 107). Using modified matched pairs, LOS of PC patients seen within 48 hours of admission average 1.67 days less compared to non-PC patients. LOS for ICU patients with PC services in the ICU within the first 48 hours decreased by 1.12 days. Overall cost avoidance was 1.5 times total cost for PC programs systemwide. One pilot project using a full-time physician in the ICU reduced cost more than $600,000, with 315 saved ICU days, annualized. Systemwide, 69.3% of all referrals to hospice were made by the PC service.
  
  
  CONCLUSIONS
  Early involvement of PC services emerged as advantageous to the net benefit. Given that health care's changing landscape will increasingly include bundled payment and risk holding strategies to improve quality and reduce cost in health care systems, systemwide PC will play a vital role.
authors: 1 Palliative Care, Sentara Healthcare , Norfolk, Virginia.|2 Department of Internal Medicine, Eastern Virginia Medical School , Norfolk, Virginia.
authors: Parag
authors: P
authors: Bharadwaj
authors: 3 Sentara Healthcare , Norfolk, Virginia.
authors: Karen M
authors: KM
authors: Helfen
authors: 4 Sentara Princess Anne Hospital , Virginia Beach, Virginia.
authors: Leo J
authors: LJ
authors: Deleon
authors: 3 Sentara Healthcare , Norfolk, Virginia.
authors: Douglas M
authors: DM
authors: Thompson
authors: 5 Sentara Obici Hospital , Suffolk, Virginia.
authors: Jennifer R
authors: JR
authors: Ward
authors: 6 Sentara Leigh Hospital , Norfolk, Virginia.
authors: John
authors: J
authors: Patterson
authors: 7 MD Anderson Cancer Center , Houston, Texas.
authors: Sriram
authors: S
authors: Yennurajalingam
authors: 8 Cedars-Sinai Medical Center , Los Angeles, California.
authors: Joe B
authors: JB
authors: Kim
authors: 3 Sentara Healthcare , Norfolk, Virginia.
authors: Kathie S
authors: KS
authors: Zimbro
authors: 9 Massey Cancer Center, Virginia Commonwealth University , Richmond, Virginia.
authors: J Brian
authors: JB
authors: Cassel
authors: 10 Sentara Medical Group , Norfolk, Virginia.
authors: Aaron D
authors: AD
authors: Bleznak
mesh_terms: D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D005260:Female; D006738:Hospices / Q000191:economics*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics*; D008297:Male; D010166:Palliative Care / Q000191:economics*; D010359:Patient Readmission / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States