Hospital palliative care consult improves value-based purchasing outcomes in a propensity score-matched cohort
| Autor: | Zugui Zhang, Justin M. Glasgow, Vinay Maheshwari, Roshni T Guerry, Linsey O'Donnell |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Palliative care Value-Based Purchasing Patient Readmission Article 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Matched cohort 030502 gerontology Medicine Humans Propensity Score Referral and Consultation Aged Quality of Health Care Retrospective Studies Aged 80 and over business.industry Palliative Care Case-control study General Medicine Middle Aged Hospital Charges Hospitalization Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Family medicine Propensity score matching Female 0305 other medical science business Healthcare system |
| Zdroj: | Palliat Med |
| ISSN: | 1477-030X |
| Popis: | Background: 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. Aim: To understand how a palliative care consultation impacts rates of patient readmission and hospital-acquired infections associated with value-based purchasing metrics. Design: 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. Results: 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. Conclusion: 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. |
| Databáze: | OpenAIRE |
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