A palliative radiation oncology consult service reduces total costs during hospitalization
| Autor: | David Fuld, Melissa D Aldridge, Doran Ricks, Sanders Chang, Juan P. Wisnivesky, Peter May, Rolfe Sean Morrison, Kavita V. Dharmarajan, Kenneth E. Rosenzweig, Nathan E. Goldstein |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Oncology
Adult Male medicine.medical_specialty Palliative care Palliative Radiation Therapy Adolescent Total cost Context (language use) Bone Neoplasms Article Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Cost Savings Internal medicine medicine Humans 030212 general & internal medicine Propensity Score Referral and Consultation General Nursing Aged Aged 80 and over business.industry Palliative Care food and beverages Inpatient setting Health Care Costs Middle Aged Patient Acceptance of Health Care Hospitalization Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Propensity score matching Palliative radiation Radiation Oncology Female Neurology (clinical) business Cohort study |
| Popis: | Context Palliative radiation therapy (PRT) is a highly effective treatment in alleviating symptoms from bone metastases; however, currently used standard fractionation schedules can lead to costly care, especially when patients are treated in an inpatient setting. The Palliative Radiation Oncology Consult (PROC) service was developed in 2013 to improve appropriateness, timeliness, and care value from PRT. Objectives Our primary objective was to compare total costs among two cohorts of inpatients with bone metastases treated with PRT before, or after, PROC establishment. Secondarily, we evaluated drivers of cost savings including hospital length of stay, utilization of specialty-care palliative services, and PRT schedules. Methods Patients were included in our observational cohort study if they received PRT for bone metastases at a single tertiary care hospital from 2010 to 2016. We compared total costs and length of stay using propensity score-adjusted analyses. Palliative care utilization and PRT schedules were compared by χ2 and Mann-Whitney U tests. Results We identified 181 inpatients, 76 treated before and 105 treated after PROC. Median total hospitalization cost was $76,792 (range $6380–$346,296) for patients treated before PROC and $50,582 (range $7585–$620,943) for patients treated after PROC. This amounted to an average savings of $20,719 in total hospitalization costs (95% CI [$3687, $37,750]). In addition, PROC was associated with shorter PRT schedules, increased palliative care utilization, and an 8.5 days reduction in hospital stay (95% CI [3.2,14]). Conclusion The PROC service, a radiation oncology model integrating palliative care practice, was associated with cost-savings, shorter treatment courses and hospitalizations, and increased palliative care. |
| Databáze: | OpenAIRE |
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