A study at Columbia University Mailman School of Public Health found that implementing hospital-based palliative care services in NY State reduces treatment intensity at the end of life for hospitalized patients. Findings are in JAMA Network Open.
Using a large sample of hospitals, researchers analyzed data from 51 hospitals in NY between 2008 and 2014. They examined how the outcomes associated with implementing such a program may differ across different hospital types.
From 2008 to 2014, 24 hospitals implemented a palliative care program – many of which were teaching and large hospitals – and 27 hospitals reported never having had such a program. Excluded were 83 hospitals that offered palliative care for all years and as were rural hospitals and those with less than 100 beds.
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.
Implementation of palliative care was associated with a 10 percent reduction in utilization of an Intensive Care Unit (ICU) for patients who died during their hospitalization. As ICU use at the end of life has been considered a negative indicator of the quality of care, “implementing palliative care programs may be a way to improve the quality of end-of-life care for some who die in the hospital,” said Dr. May Hua, assistant professor of anesthesiology in epidemiology, and lead author.
Also, an absolute decrease in end-of-life ICU use of just 4 percent would translate to a difference in cost of about $265 million per year in the U.S., Dr. Hua noted.
The authors caution against equating quality care at the end of life with less intense care. “It may be that the ICU does provide value to patients and families in a manner that is incompletely understood.”Friday Letter Submission, Publish on January 24