Comparison of Patients Seen by an Embedded Social Worker and Nurse Practitioner Palliative Care Model in Hospital Medicine Versus Referral-Based Specialty Palliative Care and Their Acute Care Utilization Outcomes

Abstract

Background:

Hospitalized patients with serious illness often face delayed or limited access to palliative care. Embedded hospital primary palliative care (HPPC), led by social workers and nurse practitioners, may deliver more timely, needs-based support compared with referral-based specialty palliative care (SPC).

Objective:

To compare demographics, clinical characteristics, acute care utilization, and sustainability of an embedded HPPC model versus SPC in hospital medicine.

Methods:

We conducted a retrospective cohort study of adults receiving palliative care consults at a New York City academic medical center during two periods: March 2019–February 2020 (HPPC1 vs. SPC) and June 2021–May 2022 (HPPC2 vs. SPC). Variables included demographics, Karnofsky Performance Status (KPS), comorbidities, mortality index, goals-of-care documentation, ICU admission, length of stay, discharge disposition, and 30-day readmissions. Outcomes were compared across groups and periods.

Results:

HPPC patients were older (mean 69.6 vs. 65.2 years; 71.7 vs. 65.0 years), had higher KPS, lower predicted mortality, and more often pursued life-prolonging goals than SPC patients. ICU admissions and hospital stays were consistently lower in HPPC cohorts. Demographic diversity was similar, with ∼27% Black, 23% Latinx, and 30% Medicaid-insured patients in HPPC groups. Volume, patient mix, and utilization outcomes were consistent across HPPC1 and HPPC2, demonstrating sustainability.

Conclusions:

An embedded SW/NP-led palliative care model in hospital medicine improves access, reduces acute care use, and is sustainable over time. This approach supports timely, culturally sensitive, needs-based palliative care and may be scalable for hospital-based delivery.