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Timing of Palliative Care Consultation and the Impact on Thirty-Day Readmissions and Inpatient Mortality.
J Palliat Med. 2019 04; 22(4):393-399.JP

Abstract

BACKGROUND

Inpatient palliative care consultation (PCC) may reduce 30-day readmissions and inpatient mortality among seriously ill patients.

OBJECTIVE

To evaluate the impact of timing of PCC on 30-day readmissions and inpatient mortality.

DESIGN

Retrospective, observational study comparing risk-adjusted, observed-to-expected (O/E) 30-day readmissions and inpatient mortality among patients receiving inpatient PCC to all other inpatients.

SETTING/SUBJECTS

Adult patients with hospital length of stay (LOS) <30 days, primary diagnoses of circulatory, infectious, respiratory, neoplasms, injury/poisoning, and digestive system were included from eight hospitals in a single health care system.

RESULTS

Compared with non-PCC patients (n = 43,463), PCC patients (n = 6043) had a greater proportion of African Americans, Medicare, LOS ≥7 days, intensive care unit stays, discharges to skilled nursing facility and hospice, primary diagnoses of infections and neoplasms, comorbidities of congestive heart failure, cancer, and dementia, Charlson comorbidity score ≥8 (p < 0.001), and fewer males (p = 0.03). Adjusted readmission reduction attributed to PCC among 0-2-, 3-6-, and 7-30-day subgroups was 14.1%, 19.2%, and 16.4%, respectively (usual care O/E = 0.904 vs. subgroup O/Es = 0.764, 0.713, 0.741, respectively). Adjusted mortality reductions attributed to PCC among the 0-2- and 3-6-day subgroups were 19.4% and 19.1%, respectively. A 12% mortality increase was observed in the 7-30-day subgroup (usual care O/E = 0.738 vs. subgroup O/Es = 0.544, 0.547, 0.858, respectively).

CONCLUSIONS

Inpatient PCC reduces 30-day readmissions and inpatient mortality with the greatest impact demonstrated within six days of hospital admission. Early PCC should be encouraged for eligible patients.

Authors+Show Affiliations

1 Continuing Care Services, Atrium Health , Charlotte, North Carolina.2 Quality Division, Atrium Health , Charlotte, North Carolina.3 Information and Analytics Services, Atrium Health , Charlotte, North Carolina.4 Adult Acute Division, Atrium Health , Charlotte, North Carolina.5 Jersey City, New Jersey.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

30547715

Citation

Barkley, John E., et al. "Timing of Palliative Care Consultation and the Impact On Thirty-Day Readmissions and Inpatient Mortality." Journal of Palliative Medicine, vol. 22, no. 4, 2019, pp. 393-399.
Barkley JE, McCall A, Maslow AL, et al. Timing of Palliative Care Consultation and the Impact on Thirty-Day Readmissions and Inpatient Mortality. J Palliat Med. 2019;22(4):393-399.
Barkley, J. E., McCall, A., Maslow, A. L., Skudlarska, B. A., & Chen, X. (2019). Timing of Palliative Care Consultation and the Impact on Thirty-Day Readmissions and Inpatient Mortality. Journal of Palliative Medicine, 22(4), 393-399. https://doi.org/10.1089/jpm.2018.0399
Barkley JE, et al. Timing of Palliative Care Consultation and the Impact On Thirty-Day Readmissions and Inpatient Mortality. J Palliat Med. 2019;22(4):393-399. PubMed PMID: 30547715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Timing of Palliative Care Consultation and the Impact on Thirty-Day Readmissions and Inpatient Mortality. AU - Barkley,John E, AU - McCall,Andrea, AU - Maslow,Andréa L, AU - Skudlarska,Beata A, AU - Chen,Xu, Y1 - 2018/12/14/ PY - 2018/12/15/pubmed PY - 2020/7/21/medline PY - 2018/12/15/entrez KW - hospital KW - mortality KW - palliative KW - readmissions SP - 393 EP - 399 JF - Journal of palliative medicine JO - J Palliat Med VL - 22 IS - 4 N2 - BACKGROUND: Inpatient palliative care consultation (PCC) may reduce 30-day readmissions and inpatient mortality among seriously ill patients. OBJECTIVE: To evaluate the impact of timing of PCC on 30-day readmissions and inpatient mortality. DESIGN: Retrospective, observational study comparing risk-adjusted, observed-to-expected (O/E) 30-day readmissions and inpatient mortality among patients receiving inpatient PCC to all other inpatients. SETTING/SUBJECTS: Adult patients with hospital length of stay (LOS) <30 days, primary diagnoses of circulatory, infectious, respiratory, neoplasms, injury/poisoning, and digestive system were included from eight hospitals in a single health care system. RESULTS: Compared with non-PCC patients (n = 43,463), PCC patients (n = 6043) had a greater proportion of African Americans, Medicare, LOS ≥7 days, intensive care unit stays, discharges to skilled nursing facility and hospice, primary diagnoses of infections and neoplasms, comorbidities of congestive heart failure, cancer, and dementia, Charlson comorbidity score ≥8 (p < 0.001), and fewer males (p = 0.03). Adjusted readmission reduction attributed to PCC among 0-2-, 3-6-, and 7-30-day subgroups was 14.1%, 19.2%, and 16.4%, respectively (usual care O/E = 0.904 vs. subgroup O/Es = 0.764, 0.713, 0.741, respectively). Adjusted mortality reductions attributed to PCC among the 0-2- and 3-6-day subgroups were 19.4% and 19.1%, respectively. A 12% mortality increase was observed in the 7-30-day subgroup (usual care O/E = 0.738 vs. subgroup O/Es = 0.544, 0.547, 0.858, respectively). CONCLUSIONS: Inpatient PCC reduces 30-day readmissions and inpatient mortality with the greatest impact demonstrated within six days of hospital admission. Early PCC should be encouraged for eligible patients. SN - 1557-7740 UR - https://www.unboundmedicine.com/medline/citation/30547715/Timing_of_Palliative_Care_Consultation_and_the_Impact_on_Thirty_Day_Readmissions_and_Inpatient_Mortality_ L2 - https://www.liebertpub.com/doi/10.1089/jpm.2018.0399?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -