Providing palliative care consultations soon after patients with complex medical conditions are admitted to hospitals can produce cost savings, according to a study published Monday in JAMA Internal Medicine.
For the study, researchers from the Icahn School of Medicine at Mount Sinai and Ireland's Trinity College Dublin reviewed data from six cohort studies that involved a total of 133,118 adults who were admitted to U.S. hospitals between 2001 and 2015. All of the patients had at least one of seven medical conditions:
- A select neurodegenerative condition;
- Chronic obstructive pulmonary disease;
- Heart failure;
- Kidney failure; or
- Liver failure.
According to the researchers, providing a palliative care consultation within three days of hospital admission saved an average of $3,237 per patient when compared with patients who did not receive such consultations.
The researchers found that savings were most pronounced among patients with cancer when compared with patients who had other conditions. Specifically, providing the palliative care consultations to patients with cancer saved an average of $4,251 per patient, compared with an average savings of $2,105 among non-cancer patients. The researchers also found that the effects of providing palliative care consultations on costs were greater among patients with four or more comorbidities when compared with patients who had two or fewer comorbidities.
The researchers wrote that the findings "suggest that acute care hospitals may be able to reduce costs for this population by increasing palliative care capacity to meet national guidelines." For instance, the researchers noted that the American Society of Clinical Oncology's 2016 guidelines on providing palliative care suggest that patients who have advanced cancer "should receive dedicated palliative care services, early in the disease course, concurrent with active treatment."
Peter May of the Centre for Health Policy and Management at Trinity College Dublin, who co-authored the study, said, "People with serious and complex medical illness account heavily for health care spending, yet often experience poor outcomes." He continued, "The news that palliative care can significantly improve patient experience by reducing unnecessary, unwanted, and burdensome procedures, while ensuring that patients are cared for in the setting of their choice, is highly encouraging. It suggests that we can improve outcomes and curb costs even for those with serious illness."
However, the researchers wrote that although the use of palliative care in the United States has increased over the past 30 years, the services still are not being used as often as they should be. Further, the researchers said palliative care is "characterized by widespread understaffing."
How to expand palliative care
To address those issues, R. Sean Morrison, system chair of Geriatrics and Palliative Medicine at Icahn and a co-author of the study, called for:
- Federal funding for research aimed at building evidence-based palliative care strategies;
- Mandating that medical licensing exams include content on palliative care; and
- Requiring hospitals to have a qualified palliative care team in order to receive accreditation.
Morrison said, "If palliative care is going to achieve its maximal effect, we will need to ensure that investment continues to grow the needed evidence base, that training and education in the core knowledge and skills of palliative care is formally integrated into medical school and residency training programs, and that accreditation and quality requirements specifically include palliative care" (Jenkins, MedPage Today, 4/30; May et al., JAMA Internal Medicine, 4/30).
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