Journal Palliat Med

Association Between Opening a Palliative Care Unit and Hospital Care for Patients with Serious Illness

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

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Prospective Identification of Patients at Risk for Unwarranted Variation in Treatment

Journal Palliat Med
Kelley AS, Bollens-Lund E, Covinsky KE, Skinner JS, Morrison RS

Understanding factors associated with treatment intensity may help ensure higher value healthcare. We identified people with incident serious illness (a serious medical condition, for example, metastatic cancer or functional impairment); calculated subjects' one-year mortality risk; and then followed them for one year. We examined relationships between individual and regional characteristics and total Medicare costs, and then stratified analyses by one-year mortality risk: low, moderate, and high.

Among seriously ill older adults, indicators of poor health are associated with higher costs. Yet, among those with poorest prognoses, nonmedical characteristics-race and regional practice patterns-have greater influence on treatment. This suggests there may be novel opportunities to improve care quality and value by assuring patient-centered, goal-directed care.