While many hospice and palliative care providers are focused on community-based care that allows patients to age in place, even palliative care provided in a hospital can reduce utilization of higher-acuity care, such as the intensive care unit (ICU).
Palliative care reduces treatment intensity at the end-of-life for hospitalized patients, according to new study on JAMA Network Open.
Between 2008 and 2014, more than 20 hospitals in New York state implemented a palliative care program; 27 hospitals examined in the study reported that they did not have such programs, according to researchers from Columbia University Mailman School of Public Health. During the study period, 73,370 patients who were 18 years or older died during hospitalization, of whom slightly more than half received care in hospitals that implemented palliative care.
“High-intensity care at the end of life has the potential to be discordant with patient preferences and non-beneficial. Therefore, both the use of intensive care during the last 30 days of life and dying in an acute care setting are considered negative indicators of the quality of end-of-life care,” the study indicated. “Implementation of palliative care was associated with a 10% reduction in the utilization of an intensive care unit for patients who died during their hospitalization.”
The researchers found that a 4% reduction in ICU utilization at the end of life would save an estimated $265 million in health care costs.
Funding from the National Institute on Aging, the American Federation for Aging Research, the National Institutes of Health, the National Palliative Care Research Center and the Mount Sinai Older Adult Independence Center financed the research.
Currently 72% of hospitals in the United States with 50 or more beds have a palliative care program. This is up from 67% in 2015 and 7% in 2001, according to the Center to Advance Palliative Care. These institutions care for 87% of all hospitalized patients nationwide. Large nonprofit hospitals in large cities are the most likely to provide palliative care.
“We observed that the association of implementing hospital-based palliative care was not consistent across different types of hospitals, with significant associations confined to teaching and large hospitals,” the researchers reported. “Furthermore, in these hospitals, implementing palliative care was also associated with a significant decrease in the number of days in the ICU for patients admitted to the ICU, suggesting that the association extended beyond simply preventing admission to the ICU.”
