A Retrospective Study Analyzing a Palliative Care-Hospital Medicine Collaboration to Improve Quality of Care of Patients With Advanced Illness

Abstract

Background

Palliative care seeks to improve outcomes for patients with advanced illness (AI). Advocacy exists for making it part of mainstream care for hospitalized patients with AI.

Aim

To determine if a partnership between hospital-medicine and specialized palliative care would increase identification of AI patients with palliative care needs requiring palliative consultation. Secondary outcomes: Decreasing 30-day readmission, length of stay (LOS) and pain scores, increasing documentation reflecting goals and advanced care planning.

Design

Retrospective chart review of patients with AI admitted to a hospitalist-resident run unit divided into Care Models, “A” and “B,” and analyzed over two ten-month periods, “1” and “2.” Triggers for palliative needs were provided for “A.” During biweekly rounding, needs were assessed and generalist vs. specialist level palliative care concepts were used for consultation.

Setting

Quaternary-level teaching center in the New York Metropolitan area.

Patients

3,395 AI patients were analyzed, 1,707 from “1,” and 1,688 from “2.”

Results

Comparing care models and time frames, palliative care consultation increased in “A” (P-value = .0013, P-value = .0005). When investigating “A” in “1” to “2,” CMI was higher. Comparing “B” between “1” and “2,” found older age and lower LACE. When adjusting for confounders (LACE and CMI), our models did not show a difference. Data on discharge disposition was significant for subacute rehab but not for mortality. There were no differences between care models and time-periods for secondary outcomes.

Conclusion

Our study demonstrated the demand for palliative care services integrated into hospital medicine and highlighted areas of focus for future studies.