Previous studies indicate that approximately half of Medicare spending is accounted for by those with four or more comorbidities, yet this group experiences poor outcomes including unmanaged symptoms and unmet needs. “Too often, care is fragmented, inappropriately intensive and inconsistent with patient preferences,” says Peter May, PhD. Palliative care may lower costs for hospitalized adults, but the evidence supporting this notion has important limitations.
For a study published in JAMA Internal Medicine, Dr. May and colleagues sought to estimate the association of palliative care consultation (PCC) within 3 days of admission with direct hospital costs for adults with serious illness. The study team identified six studies with a total 133,118 patients, of whom 93.2% were discharged alive, 40.8% had a primary diagnosis of cancer, and 3.6% received a PCC. Economic evaluations of interdisciplinary PCC for hospitalized adults with at least one of seven illnesses (cancer; heart, liver, or kidney failure; COPD; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only were assessed.
When patients were pooled irrespective of diagnosis, a statistically significant reduction in costs occurred with the use of PCC within 3 days of admission (−$3237; −$3581 to −$2893). In the stratified analyses, reductions were observed for cancer (−$4251; −$4664 to −$3837) and noncancer (−$2105; −$2698 to −$1511) subsamples. The reduction in cost was greater in those with four or more comorbidities than for those with two or fewer.
“We found that palliative care not only reduced intensity of hospital stay (eg, by reducing use of futile treatment) but also reduced length of stay,” adds Dr. May. “The reduction in costs being highest for the multimorbid group suggests that, while all patients with a life-limiting illness may benefit from palliative care, expert symptom management and increased patient decision making is most effective for the complex group who experience poor outcomes and high costs. This is in contrast to the health system’s established pattern of providing acute, episodic, single-disease-focused treatment. The fact that length of stay is shortened suggests that involving patients in decision making may expedite discharge, which we know from other studies is a priority for patients but less so for physicians. We urge hospital physicians to consider the involvement of palliative care teams early in the treatment of those with serious illness, particularly those with cancer, multimorbidity, or both.”
Rebecca Shover