176158 Economic evaluation of palliative care at the end of life

Wednesday, October 29, 2008: 1:00 PM

Irena Pesis-Katz, PhD , School of Nursing, University of Rochester, Rochester, NY
Helena Temkin-Greener, PhD , Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Timothy Quill, MD , Center for Palliative Care and Ethics, University of Rochester School of Medicine, Rochester, NY
Susan Ladwig, MPH , Center for Palliative Care and Ethics, University of Rochester School of Medicine, Rochester, NY
Sally Norton, RN, PhD , University of Rochester School of Nursing, Rochester, NY
Norman Lindenmuth, MD , Medical Affairs, Excellus BlueCross BlueShield, Syracuse, NY
Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
Palliative Care Consultation (PCC) programs are playing an increasingly important role in end-of-life care. However, the evidence regarding their financial impact is still mixed. The objective of this study is to evaluate the impact of a PCC program on hospital's costs.

The study compares 281 PC patients with 973 non-PC patients who died at the same large academic medical center in Rochester, NY between 09/30/2006-06/30/2006. We examine the independent impact of PCC on total hospital daily-costs as well as the timing of PCC services and their impact on costs. We model total hospital daily-costs by estimating a mixed linear regression model, controlling for severity-of-illness and other patients' characteristics (such as age, race and marital status).

The average daily-costs for PC day was 16.3% lower than average daily-costs for non-PC day ($1,172.5 and $1,363.8 respectively; p<0.01). Based on the multivariate analysis, we find that PCC lowers daily-costs at a much faster rate than usual care and is the strongest independent predictor of costs. Lower patient age, admission to surgical unit, and increased severity-of-illness were all associated with increased daily-costs (p<0.01). Extrapolating these findings, PCC programs can potentially save about $6 million annually, if provided to all hospital decedents.

In addition to the potential for cost savings our findings suggest that earlier provision of PCC may also lead to further decrease in the average daily cost of care earlier in the admission and to lower total costs.

Learning Objectives:
1) Describe the role of palliative care at the end of life in an acute care setting. 2) Evaluate the impact of palliative care consultation on total daily costs in an acute care setting. 3) Identify other hospital level characteristics and patient level characteristics that impact the daily cost of care at the end of life.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This study represents my own work
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Excellus BlueCross BlueShield Quality Improvement Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: End of Life Issues
See more of: Gerontological Health