1 Department of Internal Medicine, Christiana Care Health System, Newark, DE, USA.
2 Value Institute, Christiana Care Health System, Newark, DE, USA.
Palliat Med. 2019 Apr;33(4):452-456. doi: 10.1177/0269216318824270. Epub 2019 Feb 7.
Hospital-based palliative care consultation is consistently associated with reduced hospitalization costs and more importantly with improved patient quality of life. As healthcare systems move toward value-based purchasing rather than fee-for-service models, understanding how palliative care consultation is associated with value-based purchasing metrics can provide evidence for expanded health system support for a greater palliative care presence.
To understand how a palliative care consultation impacts rates of patient readmission and hospital-acquired infections associated with value-based purchasing metrics.
Retrospective propensity-matched case-control study evaluating the impact of palliative care consultation on hospital charges, hospital and intensive care unit length of stay, readmission rates, and rates of hospital-acquired conditions.
SETTING/PARTICIPANTS: All adult patients admitted to a two hospital healthcare system over a 2-year period from 1 April 2015 to 31 March 2017. The palliative care team involved three physicians, five advanced practice providers, a social worker, and a chaplain during the study period.
A total of 3415 patients receiving a palliative consult were propensity matched to 25,028 controls. Compared to controls, cases had decreased charges per day and decreased rates of 7-, 30-, and 90-day readmissions.
Through value-based purchasing, hospitals have 3% of their Medicare reimbursements at risk based on readmission rates. By clarifying prognosis and patient goals, palliative care consultation reduces readmission rates. Hospital systems may want to invest in larger palliative care programs as part of their efforts to reduce hospital readmissions.
基于医院的姑息治疗咨询一直与降低住院费用相关，更重要的是与提高患者生活质量相关。随着医疗保健系统转向基于价值的采购，而不是按服务收费的模式，了解姑息治疗咨询如何与基于价值的采购指标相关，可以为扩大卫生系统对更大程度的姑息治疗支持提供证据。
了解姑息治疗咨询如何影响与基于价值的采购指标相关的患者再入院率和医院获得性感染率。
回顾性倾向评分匹配病例对照研究，评估姑息治疗咨询对医院收费、住院和重症监护病房住院时间、再入院率以及医院获得性疾病发生率的影响。
设置/参与者：在 2015 年 4 月 1 日至 2017 年 3 月 31 日期间，从两个医院医疗系统中随机抽取的所有成年患者，共 3415 例患者接受姑息治疗咨询，并与 25028 例对照进行倾向评分匹配。在研究期间，姑息治疗团队由 3 名医生、5 名高级执业医师、1 名社会工作者和 1 名牧师组成。
与对照组相比，接受姑息治疗咨询的患者每天的费用降低，7 天、30 天和 90 天的再入院率降低。
通过基于价值的采购，医院有 3%的医疗保险报销面临再入院率的风险。姑息治疗咨询通过明确预后和患者目标降低了再入院率。医院系统可能希望投资更大的姑息治疗项目，作为降低医院再入院率的努力的一部分。
