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Worster B, Zhu Y, Garber G, Kieffer S, Smith-McLallen A. The impact of outpatient supportive oncology on cancer care cost and utilization. Cancer 2024. [PMID: 38642373 DOI: 10.1002/cncr.35332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Supportive oncology (SO) care reduces symptom severity, admissions, and costs in patients with advanced cancer. This study examines the impact of SO care on utilization and costs. METHODS Retrospective analysis of utilization and costs comparing patients enrolled in SO versus three comparison cohorts who did not receive SO. Using claims, the authors estimated differences in health care utilization and cost between the treatment group and comparison cohorts. The treatment group consisting of patients treated for cancer at an National Cancer Institute-designated cancer center who received SO between January 2018 and December 2019 were compared to an asynchronous cohort that received cancer care before January 2018 (n = 60), a contemporaneous cohort with palliative care receiving SO care from other providers in the Southeastern Pennsylvania region during the program period (n = 86), and a contemporaneous cohort without palliative care consisting of patients at other cancer centers who were eligible for but did not receive SO care (n = 393). RESULTS At 30, 60, and 90 days post-enrollment into SO, the treatment group had between 27% and 70% fewer inpatient admissions and between 16% and 54% fewer emergency department visits (p < .05) compared to non-SO cohorts. At 90 days following enrollment in SO care, total medical costs were between 4.4% and 24.5% lower for the treatment group across all comparisons (p < .05). CONCLUSIONS SO is associated with reduced admissions, emergency department visits, and total costs in advanced cancer patients. Developing innovative reimbursement models could be a cost-effective approach to improve care of patients with advanced cancer.
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Affiliation(s)
- Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Yifan Zhu
- Independence Blue Cross, Philadelphia, Pennsylvania, USA
| | - Gregory Garber
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Sawyer Kieffer
- Department of Medicine, Jefferson Health, Philadelphia, Pennsylvania, USA
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Hadler RA, Gao Y, Beck B, Moeckli J, Massarweh N, Mosher H, Vaughan-Sarrazin M. Palliative Care Utilization and Hospital Transfers in Veterans Treated in Telecritical Care-Supported Intensive Care Units Versus Non-Telecritical Care Intensive Care Units. J Palliat Med 2024. [PMID: 38324007 DOI: 10.1089/jpm.2023.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background: Although telecritical care (TCC) implementation is associated with reduced mortality and interhospital transfer rates, its impact on goal-concordant care delivery in critical illness is unknown. We hypothesized that implementation of TCC across the Veterans' Health Administration system resulted in increased palliative care consultation and goals of care evaluation, yielding reduced transfer rates. Methods: We included veterans admitted to intensive care units between 2008 and 2022. We compared palliative care consultation and transfer rates before and after TCC implementation with rates in facilities that never implemented TCC. We used generalized linear mixed multivariable models to assess the associations between TCC initiation, palliative care consultation, and transfer and subsequently used mediation analysis to evaluate potential causality in this relationship. Results: Overall, 1,020,901 veterans met inclusion criteria. Demographic characteristics of patients were largely comparable across groups, although TCC facilities served more rural veterans. Palliative care consultation rates increased substantially in both ever-TCC and never-TCC hospitals during the study period (2.3%-4.3%, and 1.6%-4.7%, p < 0.01). Admissions post-TCC implementation were associated with an increased likelihood of palliative care consultation (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01-1.15). TCC implementation was also associated with a reduction in transfer rates (OR 0.90, 95% CI 0.84-0.95). Mediation analysis did not demonstrate a causal relationship between TCC implementation, palliative care consultation, and reductions in interhospital transfer rate. Conclusions: TCC is associated with increased palliative care engagement, while TCC and palliative care engagement are both independently related to reduced transfers.
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Affiliation(s)
- Rachel A Hadler
- VA Quality Scholars Fellow, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Department of Anesthesiology, Emory University, Atlanta, Georgia, USA
- Emory Critical Care Center, Emory University, Atlanta, Georgia, USA
- Division of Palliative Care, Department of Geriatrics and Extended Care, Atlanta Veterans Administration Health Care System, Decatur, Georgia, USA
| | - Yubo Gao
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Brice Beck
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Jane Moeckli
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Nader Massarweh
- Department of Surgery, Atlanta Veterans Administration Health Care System, Decatur, Georgia, USA
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Hilary Mosher
- Geriatric Research Education and Clinical Center, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Mary Vaughan-Sarrazin
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
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Rogers M, Heitner R, Frydman JL, Bowman B, Meier DE, Aldridge M, Franzosa E. Perceptions of Palliative Care Program Viability During the Pandemic: Qualitative Results From a National Survey. Am J Hosp Palliat Care 2023; 40:1394-1399. [PMID: 36636994 PMCID: PMC9841202 DOI: 10.1177/10499091231152610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Palliative care programs have played a significant role during the COVID-19 pandemic. However, the financial impact of the pandemic and operational challenges for palliative care programs have raised concerns for their future viability. Objectives: To explore palliative care program leaders' perceptions of the future viability of their programs in the context of the pandemic and inform future educational and program development. Methods: Surveys were sent to 1430 specialist palliative care program leaders, identified through the Center to Advance Palliative Care's contact lists, via email in May 2020 and January 2021. Leaders were asked why they were or were not concerned about the viability of their palliative care programs. Qualitative content analysis was applied to determine themes. Results: We received 440 responses. Most programs served hospital settings and were geographically located across all US regions. We identified four themes: 1) The importance of being valued by organizational leadership and peers, 2) The importance of adequate and supported palliative care staff, 3) The pandemic validated and accelerated the need for palliative care, and 4) The pandemic perpetuated organizational financial concerns. Conclusion: Findings provide insights about palliative care program viability from the perspective of program leaders during a global pandemic. Technical assistance to support palliative care teams and their relationships with stakeholders, methods to measure the impact of peer support, efforts to educate administrators about the value of palliative care, and efforts to reduce burnout are needed to sustain palliative care programs into the future.
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Affiliation(s)
- Maggie Rogers
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Rachael Heitner
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Julia L. Frydman
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Brynn Bowman
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Diane E. Meier
- Center to Advance Palliative Care
at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
- James J. Peters VA Medical
Center, Bronx, NY, USA
| | - Emily Franzosa
- Brookdale Department of Geriatrics
and Palliative Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
- James J. Peters VA Medical
Center, Bronx, NY, USA
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Sumarsono N, Sudore RL, Smith AK, Pantilat SZ, Anderson WG, Makam AN. Availability of Palliative Care in Long-Term Acute Care Hospitals. J Am Med Dir Assoc 2021; 22:2207-2211. [PMID: 33965406 PMCID: PMC10186213 DOI: 10.1016/j.jamda.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the availability of palliative care programs in long-term acute care hospitals (LTACHs) DESIGN: Cross-sectional analysis using the 2016 American Hospital Association (AHA) Annual Survey. SETTING AND PARTICIPANTS LTACHs in the United States. METHOD We used descriptive analyses to compare the prevalence of palliative care programs in LTACHs across the United States in 2016. For LTACHs without a program, we also examined palliative care physician capacity in regions where those LTACHs resided to evaluate if expertise existed in those regions. RESULTS One-third (36.5%) of 405 LTACHs (50.6% response rate) self-reported having a palliative care program. Among LTACHs without palliative care, 42.4% were in regions with the highest palliative care physician capacity nationwide. CONCLUSIONS AND IMPLICATIONS LTACHs care for patients with serious and prolonged illnesses, many of whom would benefit from palliative care. Despite this, our study finds that specialty palliative care is limited in LTACHs. The limited palliative care availability in LTACHs is mismatched with the needs of this seriously ill population. Greater focus on increasing palliative care in LTACHs is essential and may be feasible as 40% of LTACHs without a palliative care program were located in regions with the highest palliative care physician capacity.
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Affiliation(s)
- Nathan Sumarsono
- University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Rebecca L Sudore
- Division of Geriatrics, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, University of California, San Francisco, CA, USA
| | - Wendy G Anderson
- Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Supportive and Palliative Care Program, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Anil N Makam
- Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA.
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