Online Program

Effect of Palliative Care Consults on Acute Care Use for Residents with Dementia in Nursing Homes

Tuesday, November 3, 2015 : 3:10 p.m. - 3:30 p.m.

Susan C. Miller, PhD, School of Public Health, Brown University, Warwick, RI
Julie L Lima, PhD, Brown School of Publich Health, Providence, RI
Orna Intrator, PhD, University of Rochester, Rochester, NY
Edward Martin, MD, MPH, Home & Hospice Care of Rhode Island, Providence, RI
Janet Bull, MD, Four Seasons, Flat Rock, NC
Laura C Hanson, MD, MPH, Sheps Center for Health Services Research, University of North Carolina at Chapel HIll, Chapel Hill, NC
This research aimed to understand whether palliative care (PC) consults received by nursing home (NH) residents with dementia affect acute care use. Two providers of PC consults in 46 NHs in 2 states identified NH consult recipients between 2005 and 2010. We merged these data with Medicare resident assessment and claims data to identify dementia and death between 2006 and 2010. Two analytic groups represented the time between first consult and death: ≤ 30 and 31-180 days. Three controls for each consult decedent were selected using propensity score matching with replacement. Weighted multivariate logistic regressions determined the effect of PC consults on hospital death, and in the last 30 days of life, on any hospital or ER use. Residents with consults within 30 days of death (compared to controls) had a significantly lower likelihood of hospital death (AOR 0.04; 95% CI 0.007, 0.196). Those with consults in the last 31-180 days of life (compared to controls) had a significantly lower likelihood of hospital death (AOR 0.006; 95% CI 0.000, 0.170), and in the last 30 days of life, hospitalization (AOR 0.15; 95% CI 0.056, 0.387) and ER use (AOR 0.18; 95% CI 0.046, 0.682). Consults extend PC access to NH residents, which is especially important for residents with dementia for whom the Medicare required six-month terminal prognosis impedes timely hospice enrollment. Medicare reimbursement policies supporting the provision of PC consults are needed to incentivize provider participation in this (currently unprofitable) PC model. Such policy could potentially result in Medicare savings.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe how the receipt of palliative care consults affects acute care use for persons dying in nursing homes with dementia.

Keyword(s): End-of-Life Care, Dementia

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For 17 years I have been studying hospice and palliative care in nursing homes, and much of my research has focused on persons with dementia. My PhD is in public health with a focus on gerontology and epidemiology.
Any relevant financial relationships? No

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.