Objective: To examine the effect of a hospital based palliative care consultation team (PCCT) on hospital utilization and costs.
Design: Retrospective case-control study. Setting: 1,000 bed academic medical center in New York City.
Subjects: 152 Medicare patients followed by the PCCT and 356 Medicare patients who did not receive palliative care who died in hospital.
Methods: Patients receiving palliative care consultation (PCC) in 2002 with a length of stay of over 14 days were matched by age, diagnostic-related group, insurance status (Medicare), to control patients not receiving palliative care. We compared hospital length of stay, intensive care unit (ICU) utilization, hospital costs, pharmacy costs, and ancillary costs for the two groups.
Results: Palliative care consultation was associated with a mean reduction in overall length of stay of 1.3 days/patient for patients with a los over 14 days, 5.4 days/patient for patients with a los over 21 days, and 10.9 days/patient for patients with a los over 28 days. Additionally, PCC was associated with a reduction in 2.7 ICU days/patient for patients with a los over 14 days, 1.6 ICU days/patient for patients with a los over 21 days, and 5.6 ICU days/ patient for patients with a los over 28 days. Total hospital savings associated with PCC were $866,806 as compared to control patients for all patients with a los over 21 days. For the 72 hours prior to death, PCC was associated with net reductions of $60 in pharmacy costs and $571 in ancillary costs per patient as compared to control patients.
Conclusion: Palliative care consultation not only provides high quality clinical care to seriously ill patients and their families but is associated with reductions in overall hospital costs, ancillary costs, pharmacy costs, and intensive care unit utilization. These findings provide further incentives for U.S. hospitals to develop palliative care programs.