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Study shows palliative care associated with shorter hospitalizations and reduced medical costs

Palliative care consultations administered within three days of admission are linked to shorter hospitalizations and significant cost savings for chronically ill adults, according to a large meta-analysis study involving researchers at VCU Massey Cancer Center.

The investigation revealed that hospitals saved an average of $3,237 per patient when treatment for complex illnesses included palliative care, a team-based practice focused on symptom management and improved care coordination.

These findings, recently published in JAMA Internal Medicine, indicate that the greatest cost reduction attributed to palliative care was seen among cancer patients. For these individuals, hospitals saved an average of $4,251 per stay compared to an average of $2,105 for patients with non-cancer ailments.

“Extensive research has highlighted the value of palliative care with regards to improving symptoms, psychological and spiritual distress in patients with cancer,” said study co-author Egidio Del Fabbro, M.D., palliative care program director and member of the Developmental Therapeutics research program at Massey as well as the Massey Endowed Chair in Palliative Care. “Remarkably, interdisciplinary palliative care appears to achieve these patient benefits and simultaneously reduces health care costs.”

The study, led by investigators at the Icahn School of Medicine at Mount Sinai in New York and Ireland's Trinity College Dublin, builds on 15 years of research conducted by Massey’s internationally renowned palliative care program.

“Our group was one of the first to publish financial outcomes of palliative care for cancer patients and others in 2003 with support from the Jessie Ball DuPont Fund,” said study co-author J. Brian Cassel, Ph.D., Massey’s director of palliative care research and member of Massey’s Cancer Prevention and Control research program. “We have continued to publish studies of VCU data using the Massey Data Analysis System and to collaborate with other leading researchers in the U.S. and abroad.”

For the meta-analysis, researchers analyzed six previous studies on the economic impact of palliative care, several of which were conducted at Massey. Overall, the studies provided a data pool of 130,000 adult patients. These individuals were admitted to hospitals in the United States between 2001 and 2015 for treatment of complex health conditions.

Data showed that patients who were seen by a palliative care team experienced lower hospital costs and shorter hospitalizations. The impact was more pronounced for the sickest patients.

“This study confirms that palliative care consultation reduces the cost of hospitalization, and that the reduction is larger for patients with cancer and those with more comorbidities,” said Cassel.

The results suggest that increasing palliative care capacity in acute care hospitals may reduce costs for adults with complex health issues. Such evidence could lead to increased efforts to address palliative care staffing shortages and evaluations of the care currently provided to chronically ill populations.

“Hopefully, these findings will encourage health systems to develop comprehensive palliative care services similar to Massey’s palliative care program,” said Del Fabbro. “This study underscores the need to develop and sustain a robust interdisciplinary palliative care model.”

Cassel agreed that the study could have far-reaching implications for the larger health care community as a whole.

"With publication in JAMA Internal Medicine, the findings are brought to the attention of leaders in cancer research and health policy across the US and abroad,” he said.

The next step will be to further explore the pooled dataset and to conduct additional research to understand why the cost-reduction effect is greater for patients with cancer.

“We also want to find out whether different kinds of cancer such as solid tumors versus hematologic malignancies affect the results,” said Del Fabbro.

In the meantime, the results of the study are expected to have a positive impact on Massey’s palliative care program.

“Through such high-profile research, our palliative care program here at Massey maintains its exceptional status,” said Cassel. “That status helps with securing funding for future research here and for multi-site studies.”

Del Fabbro and Cassel collaborated on this study with Peter May, Ph.D., and Charles Normand, D.Phil., from the Centre for Health Policy and Management at Trinity College Dublin; Robert L. Fine, M.D., and Chessie Robinson, M.A., from Baylor Scott & White Health; Reagan Menz and Corey A. Morrison from Brown University; and Joan D. Penrod, Ph.D., and R. Sean Morrison, M.D., from the James J. Peters Veterans Affairs Medical Center and the Department of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai.

This study was supported by the International Access, Rights and Empowerment Fellowship Program, which is funded by grant 24611 from The Atlantic Philanthropies, and, in part, by VCU Massey Cancer Center’s NIH-NCI Cancer Center Support Grant P30 CA016059.

The full manuscript of this study can be found online at: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2678833

Written by: Melissa Mitchell

Posted on: August 23, 2018

Category: Research