Earlier Palliative Care Referrals Associated with Reduced Length of Stay and Hospital Charges.

Abstract

<b><i>Background:</i></b> Inpatient palliative care consultation services have been shown to have a dramatic impact on the time cancer patients spend in the hospital, which directly affects overall health care charges and expenditures. <b><i>Objective:</i></b> Our study looks at early palliative care consults in patients with a variety of chronic medical conditions as well as cancer. <b><i>Design:</i></b> This is a retrospective case-control study of patients referred to the palliative care department from April 2014 to June 2016. <b><i>Setting/Subjects:</i></b> This study took place at a university-affiliated community-based urban tertiary care hospital. Cases were patients with a referral placed for a palliative care consult <24 hours after registration into the hospital. Controls were chosen on a one-to-one basis from all other patients referred 24 or more hours after registration. Participants were matched on underlying disease, Charlson comorbidity index, and date of referral. <b><i>Measurements:</i></b> Primary outcomes were hospital length of stay and total hospital charges. <b><i>Results:</i></b> The median (interquartile range) length of stay was 4.2 days (2.0-7.2) for cases and 9.7 days (6.0-18.3) for the control group; <i>p</i> < 0.001. Total hospital charges in U.S. dollars for cases and controls was $38,600 ($22,700-$66,900) and $95,300 ($55,200-$192,700), respectively; <i>p</i> < 0.001. Similar differences were seen for cancer and chronic disease cases and controls. <b><i>Conclusions:</i></b> Our study demonstrates a significant association between reduced length of stay and hospital charges when consults for palliative care were initiated within 24 hours of hospital admission regardless of underlying disease.