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Does modality matter? Palliative care units associated with more cost-avoidance than consultations
Article indépendant
CONTEXT: Inpatient palliative care is associated with reduced costs, but the optimal model for providing inpatient palliative care is unknown.
OBJECTIVES: To estimate the effect of palliative care consultations (PCC) and care in a palliative care unit (PCU) on cost of care, in comparison with usual care (UC) only and in comparison with each other.
METHODS: Retrospective cohort study, using multinomial propensity scoring to control for observed confounding between treatment groups. Participants were adults admitted as inpatients between 2009 and 2015 with at least one of seven life-limiting conditions who died within a year of admission (N=6,761).
RESULTS: Palliative care within 10 days of admission is estimated to reduce costs compared to UC in the case of both PCU (-$6333; 95% CI: -7871 to -4795; p<0.001) and PCC (-$3559; -5732 to -1387; p<0.001). PCU is estimated to reduce costs compared to PCC (-$2774; -5107 to -441; p=0.02) and LOS compared to UC (-1.5 days; -2.2 to -0.9; p<0.001). The comparatively larger effect of PCU over PCC is not observable when the treatment groups are restricted to those who received palliative care early in their admission (within six days).
CONCLUSIONS: Both PCU and PCC are associated with lower hospital costs than usual care. PCU is associated with a greater cost-avoidance effect than PCC except where both interventions are provided early in the hospitalization. Both timely provision of palliative care for appropriate patients and creation of more PCUs may decrease hospital costs.
http://dx.doi.org/10.1016/j.jpainsymman.2017.08.011
Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 55»
Autres numéros de la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»
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