Hospital outcomes for a home-based palliative medicine consulting service.

Abstract

There is a growing need for palliative care services located outside of hospitals. This study's objective was to evaluate a home-based, nonhospice, palliative medicine (PM) consultation practice within a fee-for-service environment. Hospital and emergency department (ED) utilization and cost data obtained from administrative records were analyzed with longitudinal analyses to compare use 18 months before and after service enrollment in a single patient group. Patients (N=369) with advanced complex illness (ACI) referred for home-based palliative consultation participated in the study. Consultation conducted by nurse practitioners included a multidimensional assessment with recommendations to outpatient physicians for symptom management and guidance to patient and family for goals of treatment and advanced care planning (ACP). Nurse practitioners were supported by a collaborating PM physician. Follow-up visits varied by need for symptom management and ACP. Total hospitalizations, total hospital days, total and variable costs, and probability of a 30-day readmission were significantly reduced in the 18-month period following program enrollment. However, probability of an ED visit was not reduced. While requiring replication with rigorous methods, preliminary results suggest a home-based PM practice may reduce hospital utilization for ACI patients.