title: Access to palliative care services during a terminal hospital episode reduces intervention rates and hospital costs: a database study of 19 707 elderly patients dying in hospital, 2011-2015.
abstract: BACKGROUND
  The burden of healthcare costs for persons approaching death is of increasing concern. This study examines cost savings associated with access to palliative care (PC) during a hospital episode ending in death for a large sample of elderly patients.
  
  
  METHODS
  A retrospective cohort study of administrative data for the Department of Veterans' Affairs clients identified patient demographics, hospital characteristics, utilisation data and component costs for the hospital terminal episode for patients aged ≥ 70 years who died in hospital between July 2011 and June 2015. Differences between patients with and without access to PC were analysed with descriptive statistics and negative binomial regression models.
  
  
  RESULTS
  Access to PC service was reported for 33.2% of patients, 59.5% for those with a cancer diagnosis and 24.3% for other patients. Rates were significantly lower in private hospitals for all patient groups. For the complete sample, PC access was associated with significantly lower rates of admission into the intensive care unit (1.9% vs 10.6%, P < 0.001), fewer coded procedures and lower costs for hospital accommodation, medical and diagnostic services. Mean total cost for terminal episodes was $10 801 for PC patients and $16 165 for those with no recorded PC access (P < 0.001). All differences remained significant after adjustment for patient age, comorbidity and hospital type.
  
  
  CONCLUSIONS
  In a hospital episode ending in death, access to PC services was associated with significantly lower rates of medical interventions and total hospital costs.
authors.affiliation: Department of Veterans' Affairs, Canberra, ACT, Sydney, New South Wales, Australia.|School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Ireland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual / Q000191:economics* / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000639:trends; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics* / Q000639:trends
keywords: cancer; costs; hospital; intensive care; palliative care