Why palliative care 5. The fiscal imperative Medical Spending in the US: $1.7 trillion in 2004 Palliative Care aims to improve care in 3 domains: Cost Drivers Behind that Pattern

Why palliative care 5. The fiscal imperative Medical Spending in the US: $1.7 trillion in 2004 Palliative Care aims to improve care in 3 domains: Cost Drivers Behind that Pattern www.phwiki.com

Why palliative care 5. The fiscal imperative Medical Spending in the US: $1.7 trillion in 2004 Palliative Care aims to improve care in 3 domains: Cost Drivers Behind that Pattern

Bright, Marta, Contributing Writer has reference to this Academic Journal, PHwiki organized this Journal Why palliative care 5. The fiscal imperative Population aging + growth in numbers of patients in need + effective new technologies + antiquated payment system = financial crisis as long as healthcare Wall Street Journal page 1 Sept. 18, 2003 Medical Spending in the US: $1.7 trillion in 2004 15% GNP, rising to 20% by 2015 U.S. has more per capita spending than anywhere else in the world, but ranks 20th in quality indices The costliest 5% account as long as 43% of Medicare spending Medicare Payment Policy: Report to Congress. Medpac 2004 www.medpac.gov Health Affairs 2005;24:903-14. CBO May 2005 High Cost Medicare Beneficiaries www.cbo.gov

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Palliative Care aims to improve care in 3 domains: Relieve physical in addition to emotional suffering Improve patient-physician communication in addition to decision-making Coordinate continuity of care across settings Benefits of Palliative Care: The Evidence Base Reduction in symptom burden Improved patient in addition to family satisfaction Reduced costs

Does Palliative Care Improve Outcomes Results from Systematic Reviews Meta-analyses of all studies comparing hospice/palliative care teams (2 or more health care workers) with usual care 44 studies identified 17 from the UK, 9 from Europe, 12 from the U.S. in addition to 6 from other countries 7 flawed RCTs – level 1 10 prospective controlled trials – level 2 27 retrospective, cross-sectional, observational studies – level 3 Higginson et al, JPSM, 2003; †Finlay et al, Ann Oncol 2002; Higginson et al, JPSM 2002. Hospital Based Palliative Care Teams (HBPCT) 8 studies pooled from meta-analysis, 1 additional cluster r in addition to omized controlled trial Compared to conventional care, HBPCT were associated with significant improvements in: Pain Non-pain symptoms Patient/family satisfaction (RCT) Hospital length of stay, in-hospital deaths (RCT) Jordhay et al Lancet 2000 Palliative Care Improves Quality Data demonstrate that palliative care: Relieves pain in addition to distressing symptoms Supports on-going re-evaluations of goals of care in addition to difficult decision-making Improves quality of life, satisfaction as long as patients in addition to their families Eases burden on providers in addition to caregivers Helps patients complete life prolonging treatments Improves transition management Campbell et al, Heart Lung, 1991; Campbell et al, Crit Care Med, 1997; UC Davis Health System News; 2002; Carr et al, Vitas Healthcare, 1995; Franklin Health, 2001; Dartmouth Atlas, 2000; Micklethwaite, 2002; Du Pen et al, J Clin Oncol, 1999; Finn et al, ASCO, 2002; Francke, Pat Educ Couns, 2000; Advisory Board, 2001, 2004; Portenoy, Seminars in Oncol, 1995; Irel in addition to Cancer Center, 2002; Von Roenn et al, Ann Intern Med, 1993; Finn J et al ASCO abstract. 2002; Manfredi et al JPSM 2001; Schneiderman et al. JAMA 2003; Higginson et al JPSM 2002 & 2003; Smith et al. JCO 2002, JPM 2003; Coyne et al. JPSM 2002; www.capc.org.

Symptom Improvement as long as 3,707 Palliative Care Patients at Mount Sinai Hospital (6/97-12/04) Pain Nausea Shortness of Breath Severe Mod. Mild None Severe Mod. Mild None Severe Mod. Mild None Anxiety Severe Mod. Mild None Source: Patient Interviews, Mount Sinai Hospital, New York City High Satisfaction-Mount Sinai Hospital Data Percent of Palliative Care Families Satisfied or Very Satisfied Following their Loved Ones Death with: Control of pain – 95% Control of non-pain symptoms – 92% Support of patient’s quality of life – 89% Support as long as family stress/anxiety – 84% Manner in which you were told of patient’s terminal illness – 88% Overall care provided by palliative care program- 95% Source: Post-Discharge/Death Family Satisfaction Interviews, Mount Sinai Hospital, New York City

Palliative Care Is Cost-Saving, supports transitions to more appropriate care settings Palliative care lowers costs ( as long as hospitals in addition to payers) by reducing hospital in addition to ICU length of stay, in addition to direct (such as pharmacy) costs. Palliative care improves continuity between settings in addition to increases hospice/homecare/nursing home referral by supporting appropriate transition management. Lilly et al, Am J Med, 2000; Dowdy et al, Crit Care Med, 1998; Carlson et al, JAMA, 1988; Campbell et al, Heart Lung, 1991; Campbell et al, Crit Care Med, 1997; Bruera et al, J Pall Med, 2000; Finn et al, ASCO, 2002; Goldstein et al, Sup Care Cancer, 1996; Advisory Board 2002; Davis et al J Support Oncol 2005; Smeenk et al Pat Educ Couns 2000; Von Gunten JAMA 2002; Schneiderman et al JAMA 2003; Campbell in addition to Guzman, Chest 2003; Smith et al. JPM 2003; Smith, Hillner JCO 2002; www.capc.org; Gilmer et al. Health Affairs 2005. Campbell et al. Ann Int Med.2004; Health Care Advisory Board. The New Medical Enterprise 2004. Elsayem et al, JPM 2006; Fromme et al, JPM 2006; Penrod et al, JPM 2006; Gozalo in addition to Miller, HSR 2006; White et al, JHCM 2006; How Palliative Care Reduces Length of Stay in addition to Cost Palliative care: Clarifies goals of care with patients in addition to families Helps families to select medical treatments in addition to care settings that meet their goals Assists with decisions to leave the hospital, or to withhold or withdraw death-prolonging treatments that don’t help to meet their goals How does PC reduce costs Better care coordination, more hospice Fewer deaths in hospital Presence in or good relationship with ED More admissions directly to PC not ICU, from ED Reduce severe symptoms More transfers out of, fewer into, ICUs Families, docs, nurses like the PC alternative Shorter LOS, especially in ICUs Change, clarify goals of care Less use of labs, radiology, hi $ pharmacy, blood products Higher quality, reduced variability, lower costs Specialization, volume, treatment algorithms

Mount Sinai LOS Comparison: Palliative Care vs. Usual Care 2004 Making the Financial Case: Direct Costs Prior to Death Median Day of First Palliative Care Consult All adult deaths (>18 years) as long as calendar years 2002, 2003 Length of stay greater than 10 days in addition to less than 35 days 30 most frequent DRGs as long as palliative care patients Palliative Care (N=368) Usual Care (N=1036)

Total Costs Be as long as e in addition to After Palliative Care Consultation Cost Drivers Behind that Pattern VCU Medical Center

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