title: Standardized Criteria for Palliative Care Consultation on a Solid Tumor Oncology Service Reduces Downstream Health Care Use.
abstract: Hospitalized patients with advanced cancer have a high symptom burden and need for support. Integration of palliative care (PC) improves symptom control and decreases unwanted health care use, yet many patients are never offered these services. In 2016, ASCO called for incorporation of PC into oncologic care for all patients with metastatic cancer. To improve the quality of cancer care, we developed standardized criteria, or triggers, for PC consultation on the inpatient solid tumor service.
  
  
  
  Patients were eligible for this prospective cohort study if they met at least one of the following eligibility criteria: had an advanced solid tumor; prior hospitalization within 30 days; hospitalization > 7 days; and active symptoms. During the intervention, patients who met the criteria received automatic PC consultation.
  
  
  
  When we compared patients in the intervention group with control subjects, there were increases in PC consultations (19 of 48 [39%] to 52 of 65 [80%]; P ≤ .001) and hospice referrals (seven of 48 [14%] to 17 of 65 [26%]; P = .03), and there were declines in 30-day readmission rates (17 of 48 [35%] to 13 of 65 [18%]; P = .04) and receipt of chemotherapy after discharge (21 of 48 [44%] to 12 of 65 [18%]; P = .03). There was an overall increase in support measures following discharge ( P = .004). Length of stay was unaffected.
  
  
  
  To our knowledge, this is the first study to demonstrate that among patients with advanced cancer admitted to an inpatient oncology service, the standardized use of triggers for PC consultation is associated with substantial impact on 30-day readmission rates, chemotherapy following discharge, hospice referrals, and use of support services following discharge. Expansion of this model to other hospitals and health systems should improve the value of cancer care.
authors.affiliation: Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Kerin
authors.initials: K
authors.lastname: Adelson
authors.affiliation: Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Julia
authors.initials: J
authors.lastname: Paris
authors.affiliation: Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Jay R
authors.initials: JR
authors.lastname: Horton
authors.affiliation: Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Lorena
authors.initials: L
authors.lastname: Hernandez-Tellez
authors.affiliation: Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Doran
authors.initials: D
authors.lastname: Ricks
authors.affiliation: Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
authors.affiliation: Yale University School of Medicine, New Haven, CT; New York University; Icahn School of Medicine at Mount Sinai, New York, NY; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Cardinale B
authors.initials: CB
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D012017:Referral and Consultation; D012959:Socioeconomic Factors