May Peter, Garrido Melissa M, Cassel J Brian, Kelley Amy S, Meier Diane E, Normand Charles, Smith Thomas J, Morrison R Sean
1 Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
2 Department of Geriatrics and Palliative Medicine, James J. Peters VA Medical Center, Bronx, NY, USA.
Palliat Med. 2017 Apr;31(4):378-386. doi: 10.1177/0269216317690098. Epub 2017 Feb 3.
Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear.
To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention?
Prospective multi-site cohort study (2007-2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores.
SETTING/PARTICIPANTS: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( n = 637; n = 177; n = 49) discharged alive.
Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered.
Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.
研究报告称，与仅接受常规护理相比，医院姑息治疗咨询团队可节省成本，但观察到的差异的驱动因素尚不清楚。
使用两个研究问题分析与姑息治疗咨询团队相关的成本差异：（问题1）与仅接受常规护理相比，早期姑息治疗咨询团队干预与服务强度和住院时间之间有何关联？（问题2）与后期干预相比，早期姑息治疗咨询团队干预与日常医院成本之间有何关联？
前瞻性多中心队列研究（2007 - 2011年）。接受咨询的患者被纳入干预组，未接受咨询的患者被纳入对照组。干预组按时间分层，各小组使用倾向得分进行匹配。
地点/参与者：入住美国三家医院的晚期癌症成年患者。主要分析样本包括863名存活出院的患者（n = 637；n = 177；n = 49）。
早期姑息治疗节省成本是由于住院时间缩短和治疗强度降低，估计63%的节省与住院时间缩短有关。在初次咨询后的几天内可观察到日常成本有所降低，但不会无限期持续。早期和晚期姑息治疗咨询团队成本效益的比较显示，一旦实施干预，差异可忽略不计。
住院时间缩短是晚期癌症患者早期咨询节省成本的最大驱动因素。姑息治疗咨询团队发起的以患者和家庭为中心的关于护理目标和过渡计划的讨论，在推动成本节省方面可能至少与先前研究中确定的减少不必要的检查和药物治疗同样重要。
