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abstract
"Palliative care is often confused with hospice care."
Highlights
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- Timely palliative medicine consultation is associated with improved quality of end of life care.
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- Decreased direct hospital costs are associated with timely palliative medicine consultation.
Objective
Aggressive
care interventions at the end of life (ACE) are reported metrics of
sub-optimal quality of end of life care that are modifiable by
palliative medicine consultation. Our objective was to evaluate the
association of inpatient palliative medicine consultation with ACE
scores and direct inpatient hospital costs of patients with gynecologic
malignancies.
Methods
A
retrospective review of medical records of the past 100 consecutive
patients who died from their primary gynecologic malignancies at a
single institution was performed. Timely palliative medicine
consultation was defined as exposure to inpatient consultation ≥ 30 days
before death. Metrics utilized to tabulate ACE scores were ICU
admission, hospital admission, emergency room visit, death in an acute
care setting, chemotherapy at the end of life, and hospice admission
< 3 days. Inpatient direct hospital costs were calculated for the
last 30 days of life from accounting records. Data were analyzed using
Fisher’s Exact, Mann–Whitney U, Kaplan-Meier, and Students T testing.
Results
49%
of patients had a palliative medicine consultation, 18% had timely
consultation. Median ACE score for patients with timely palliative
medicine consultation was 0 (range 0–3) versus 2 (range 0–6) p = 0.025
for patients with untimely/ no consultation. Median inpatient direct
costs for the last 30 days of life were lower for patients with timely
consultation, $0 (range 0–28,019) versus untimely, $7729 (0–52,720),
p = 0.01.
Conclusions
Timely
palliative medicine consultation was associated with lower ACE scores
and direct hospital costs. Prospective evaluation is needed to validate
the impact of palliative medicine consultation on quality of life and
healthcare costs.
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