title: The Influence of Palliative Care Consultation on Health-Care Resource Utilization During the Last 2 Months of Life: Report From an Integrated Palliative Care Program and Review of the Literature.
abstract: BACKGROUND
  We reviewed 104 consecutive deaths of veterans receiving care in the Dayton VA Medical Center from October 10, 2015 to April 11, 2016. The purpose of our study was to test our hypothesis that palliative care consultation would be associated with reduced health care resource utilization for individuals approaching end of life.
  
  
  METHODS
  Medical records were reviewed and data entry recorded on a spreadsheet. Non-parametric statistical methods were used to compare four outcome variables from veterans with palliative care consultation (PCC) vs. those without PCC. These variables included the number of ED visits, hospitalizations, hospital days, and ICU days all during the last two months of life. Predictor variables included PCC vs. no PCC and PCC before vs. PCC during the last two months of life. The study sample was comprised of 102 patients after excluding two outlier cases with ethical challenges in surrogate decision-making.
  
  
  RESULTS
  Of the 102 consecutive veteran deaths, palliative care consultation was associated with a lower number of ICU days during the last two months of life. For 96 veterans with PCC, the frequency of ED visits and acute care hospitalizations, as well as the number of ICU and hospital days, were all significantly less after PCC compared to before PCC during the last two months of life. The timing of PCC had no effect on the outcomes of interest.
  
  
  CONCLUSIONS
  Palliative care consultation has a notable effect on health care resource utilization during the last two months of life.
authors.affiliation: 1 Dayton VA Medical Center, Dayton, OH, USA.|2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Dunn
authors.affiliation: 1 Dayton VA Medical Center, Dayton, OH, USA.|2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Markert
authors.affiliation: 1 Dayton VA Medical Center, Dayton, OH, USA.|2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hayes
authors.affiliation: 1 Dayton VA Medical Center, Dayton, OH, USA.|2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: McCollom
authors.affiliation: 1 Dayton VA Medical Center, Dayton, OH, USA.|2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: Loveleen
authors.initials: L
authors.lastname: Bains
authors.affiliation: 1 Dayton VA Medical Center, Dayton, OH, USA.|2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: Damanjeet
authors.initials: D
authors.lastname: Kahlon
authors.affiliation: 1 Dayton VA Medical Center, Dayton, OH, USA.|2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: Geetika
authors.initials: G
authors.lastname: Kumar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
keywords: business case for palliative care; emergency room; end of life; hospitalizations; inpatient and outpatient palliative care; length of stay; palliative care consultation; visits