May Peter, Garrido Melissa M, Cassel J Brian, Kelley Amy S, Meier Diane E, Normand Charles, Stefanis Lee, Smith Thomas J, Morrison R Sean
Peter May (
Melissa M. Garrido is a health services researcher at the James J. Peters Veterans Affairs (VA) Medical Center, in the Bronx, New York, and an assistant professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai.
Health Aff (Millwood). 2016 Jan;35(1):44-53. doi: 10.1377/hlthaff.2015.0752.
Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially as a result of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2-3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending.
患有多种严重疾病的患者在医疗保健支出中占比很高。由于保险资格增加、护理成本不断上升、临终时继续使用无益的高强度治疗以及人口结构变化，预计此类支出将继续大幅增长。我们评估了姑息治疗咨询对晚期癌症成年患者（不包括痴呆患者）住院费用的影响。我们发现，与常规护理相比，入院后两天内接受姑息治疗咨询的患者，合并症评分为2 - 3的患者成本降低了22%，评分为4或更高的患者成本降低了32%。还发现，对于由多种合并症定义的所有子样本，早期咨询与更大的成本节约效果存在系统性关联。鉴于目前劳动力短缺，针对患有晚期癌症且同时患有较多严重疾病的住院患者提供早期专科姑息治疗，在补充控制医疗支出增长策略的同时，还可改善护理。
