The economic and clinical impact of an inpatient palliative care consultation service: A multifaceted approach

Background: While there has been a rapid increase of inpatient palliative care (PC) programs, the financial and clinical benefits have not been well established. Objective: Determine the effect of an inpatient PC consultation service on costs and clinical outcomes. Design: Multifaceted study included: (1) interrupted time-series design utilizing mean daily costs preintervention and postintervention; (2) matched cohort analysis comparing PC to usual care patients; and (3) analysis of symptom control after consultation. Setting: Large private, not-for-profit, academic medical center in San Francisco, California, 2004 - 2006. Subjects: Time series analysis included 282 PC patients; matched cohorts included 27 PC with 128 usual care patients; clinical outcome analysis of 48 PC patients. Main outcome measure(s): Mean daily patient costs and length of stay (LOS); pain, dyspnea, and secretions assessment scores. Results: Mean daily costs were reduced 33% (p < 0.01) from preintervention to postintervention period. Mean length of stay (LOS) was reduced 30%. Mean daily costs for PC patients were 14.5% lower compared to usual care patients (p < 0.01). Pain, dyspnea, and secretions scores were reduced by 86%, 64%, and 87%, respectively. Over the study period, time to PC referral as well as overall ALOS were reduced by 50%. Conclusions: The large reduction in mean daily costs and LOS resulted in an estimated annual savings of $2.2 million in the study hospital. Our results extend the evidence base of financial and clinical benefits associated with inpatient PC programs. We recommend additional study of best practices for identifying patients and providing consultation services, in addition to progressive management support and reimbursement policy.