Palliative care consultations linked to reduced hospitalization, ED care

LAKE BUENA VISTA, FLA. – Palliative care consultations were linked to decreases in hospitalizations and hospital days, as well as emergency department visits, among pediatric patients with life-threatening or terminal conditions, according to a retrospective chart review at a large children’s hospital.

The 36 patients in the study – patients at Rady Children’s Hospital–San Diego, ranged in age from 1 to 24 years; most had a neurological diagnosis and none had cancer. The Pediatric Advanced Care Team (PACT) services at the hospital include consultations with patients and their families to clarify goals of care, which are then used to determine treatment options and to define limits of therapy.

In 2009, the year prior to implementation of PACT, the 36 patients had 121 hospitalizations; in the year after their PACT consultations, the patients had 61 hospitalizations, Dr. Ami Doshi reported at the Pediatric Hospital Medicine 2014 annual meeting.

Emergency department visits decreased from 100 before PACT consultation to 84 after consultation. Total hospital days exceeded 1,100 days in the year before PACT consultation compared with 684 days after consultation. Length of stay decreased significantly from 31 days to 19 days, said Dr. Doshi, a pediatrician at Rady and a PACT member.

Because of the small sample size, the findings require replication in a larger study, she said. It would be worthwhile to redo the study with cost information included.

"We cannot directly attribute the decrease in utilization to PACT intervention as a direct cause-effect relationship. Doing the study again and comparing patients with the same diagnosis who did and did not receive palliative care would eliminate some potentially confounding variables," she added, noting that it would be useful to look at ambulatory and outpatient data to see if these offset any of the inpatient findings.

As hospitals will now be negotiating for a set payment to manage each patient regardless of the setting, hospitals will be motivated to move care, resources, and the associated dollars from the inpatient to the less costly outpatient setting, Dr. Doshi said. "These data suggest that palliative care can be a prime change agent in that shift. Most importantly, it’s great that palliative care can decrease utilization, but palliative care is really, truly unique in that it can do so while simultaneously improving quality of life and improving patient and family satisfaction."

Dr. Doshi reported having no disclosures. The meeting was sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics, the AAP Section on Hospital Medicine, and the Academic Pediatric Association.

LAKE BUENA VISTA, FLA. – Palliative care consultations were linked to decreases in hospitalizations and hospital days, as well as emergency department visits, among pediatric patients with life-threatening or terminal conditions, according to a retrospective chart review at a large children’s hospital.

The 36 patients in the study – patients at Rady Children’s Hospital–San Diego, ranged in age from 1 to 24 years; most had a neurological diagnosis and none had cancer. The Pediatric Advanced Care Team (PACT) services at the hospital include consultations with patients and their families to clarify goals of care, which are then used to determine treatment options and to define limits of therapy.

In 2009, the year prior to implementation of PACT, the 36 patients had 121 hospitalizations; in the year after their PACT consultations, the patients had 61 hospitalizations, Dr. Ami Doshi reported at the Pediatric Hospital Medicine 2014 annual meeting.

Emergency department visits decreased from 100 before PACT consultation to 84 after consultation. Total hospital days exceeded 1,100 days in the year before PACT consultation compared with 684 days after consultation. Length of stay decreased significantly from 31 days to 19 days, said Dr. Doshi, a pediatrician at Rady and a PACT member.

Because of the small sample size, the findings require replication in a larger study, she said. It would be worthwhile to redo the study with cost information included.

"We cannot directly attribute the decrease in utilization to PACT intervention as a direct cause-effect relationship. Doing the study again and comparing patients with the same diagnosis who did and did not receive palliative care would eliminate some potentially confounding variables," she added, noting that it would be useful to look at ambulatory and outpatient data to see if these offset any of the inpatient findings.

As hospitals will now be negotiating for a set payment to manage each patient regardless of the setting, hospitals will be motivated to move care, resources, and the associated dollars from the inpatient to the less costly outpatient setting, Dr. Doshi said. "These data suggest that palliative care can be a prime change agent in that shift. Most importantly, it’s great that palliative care can decrease utilization, but palliative care is really, truly unique in that it can do so while simultaneously improving quality of life and improving patient and family satisfaction."

Dr. Doshi reported having no disclosures. The meeting was sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics, the AAP Section on Hospital Medicine, and the Academic Pediatric Association.

LAKE BUENA VISTA, FLA. – Palliative care consultations were linked to decreases in hospitalizations and hospital days, as well as emergency department visits, among pediatric patients with life-threatening or terminal conditions, according to a retrospective chart review at a large children’s hospital.

The 36 patients in the study – patients at Rady Children’s Hospital–San Diego, ranged in age from 1 to 24 years; most had a neurological diagnosis and none had cancer. The Pediatric Advanced Care Team (PACT) services at the hospital include consultations with patients and their families to clarify goals of care, which are then used to determine treatment options and to define limits of therapy.

In 2009, the year prior to implementation of PACT, the 36 patients had 121 hospitalizations; in the year after their PACT consultations, the patients had 61 hospitalizations, Dr. Ami Doshi reported at the Pediatric Hospital Medicine 2014 annual meeting.

Emergency department visits decreased from 100 before PACT consultation to 84 after consultation. Total hospital days exceeded 1,100 days in the year before PACT consultation compared with 684 days after consultation. Length of stay decreased significantly from 31 days to 19 days, said Dr. Doshi, a pediatrician at Rady and a PACT member.

Because of the small sample size, the findings require replication in a larger study, she said. It would be worthwhile to redo the study with cost information included.

"We cannot directly attribute the decrease in utilization to PACT intervention as a direct cause-effect relationship. Doing the study again and comparing patients with the same diagnosis who did and did not receive palliative care would eliminate some potentially confounding variables," she added, noting that it would be useful to look at ambulatory and outpatient data to see if these offset any of the inpatient findings.

As hospitals will now be negotiating for a set payment to manage each patient regardless of the setting, hospitals will be motivated to move care, resources, and the associated dollars from the inpatient to the less costly outpatient setting, Dr. Doshi said. "These data suggest that palliative care can be a prime change agent in that shift. Most importantly, it’s great that palliative care can decrease utilization, but palliative care is really, truly unique in that it can do so while simultaneously improving quality of life and improving patient and family satisfaction."

Dr. Doshi reported having no disclosures. The meeting was sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics, the AAP Section on Hospital Medicine, and the Academic Pediatric Association.