Cost of medical care at the end of life is high, especially for hospitalizations that end in death. Palliative care services have been associated with decreased costs, including lower intensive care unit (ICU) costs. Mo previous studies have specifically documented the ways patients die on a hospitalist service or the influence of palliative care services on the costs of that care.
Using hospital administrative data, we examined all patients who were admitted to the hospitalist service at a large academic medical center from September 1, 2008, to August 31, 2009, and died in the hospital during that admission. We then identified patients who did and did not receive a palliative care consultation (PCC). We examined the daily total variable costs and variable cost components incurred during each admission, and compared the cumulative per patient total variable cost for the last 3 days of life between the 2 groups. A subsequent analysis looked at the trajectory of daily variable costs relative to the day of consultation.
A total of 6704 patients were admitted to the hospitalist service and 82 died; 55% of those who died received a palliative care consultation. The median length of stay (LOS) prior to PCC was 6 days. Patients who received a PCC had longer average LOS (13.0 days vs. 8.4 days, P = 0.007) and fewer transfers to the ICU (40% vs. 73%, (P < 0.001). However, the median LOS for the 2 groups did not show a statistically significant difference (9 vs. 7 days, P = 0.48). The average total variable costs per patient over the last 3 days of life were significantly lower for those patients who received a PCC than for those who did not ($2288 vs, $6389, P < 0.001). The lower average costs are explained by decreased costs for most hospital services including ICU, imaging, lab, respiratory therapy, and pharmacy costs. When looking at the trajectory of daily variable costs relative to the day of consultation, there seems to be 3 distinct phases, with inflections occurring the day before PCC and the day after PCC. The average total vahable cost/day dropped from $1428 to $1078 (P = 0.06) from phase 1 to phase 2 and dropped again to $654 in phase 3 (P < 0.001). This phenomenon suggests that hospitalists' decisions to involve palliative care are correlated with a modification in the care they deliver to the patient. It also suggests that the care is further modified once palliative care becomes involved.
Palliative care consultation is associated with lower costs in the final days of hospitalization for admissions that end in death. The main limitation of this analysis is that palliative care involvement was entirely discretionary. Further studies need to address how physicians decide to involve palliative care and exactly how a palliative care service is associated with decreased utilization of hospital resources.
E. Szmuilowicz, none; D. Malkenson, none.
To cite this abstract:Szmuilowicz E, Malkenson D. Cost and Trajectory of Care for Dying Patients. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 142. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/cost-and-trajectory-of-care-for-dying-patients/. Accessed September 22, 2019.