The value of compassion: Healthcare savings of palliative care consults in trauma |
| |
| Institution: | 1. Department of Surgery, University of Arizona College of Medicine, 1501 North Campbell Avenue, Room 5411, Tower 4, Tucson, AZ 85724, United States of America;2. Department of Surgery, Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157, United States of America;3. Department of Biostatistics & Data Science, Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157, United States of America;4. Wake Forest University School of Medicine, Bowman Gray Center for Medical Education, 475 Vine Street, Winston-Salem, NC 27101, United States of America;5. Departments of Surgery & Internal Medicine, Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston-Salem, NC 27157, United States of America;1. Department of Community Health and Social Sciences, CUNY SPH, New York, NY, USA;2. Department of Health Policy and Management, CUNY SPH, New York, NY, USA;3. Amend, Dar es Salaam, Tanzania;4. Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY SPH, New York, NY, USA;5. Institute for Implementation Science in Population Health (ISPH), CUNY SPH, New York, NY, USA;6. Department of Epidemiology and Biostatistics, CUNY SPH, New York, NY, USA;7. Department of Family and Social Medicine, Albert Einstein College of Medicine (AECOM), Bronx, NY, USA;8. Urban Planning for Community Change (UPC), Tanzania;1. Assistant Professor- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR;2. Oregon Health & Science University, Portland, OR;3. Professor- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University, Portland, OR;1. Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;2. Department of Health Psychology, Chang Jung Christian University, Tainan 71101, Taiwan;3. Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;4. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;1. Department of Surgery, Children''s Mercy Hospital, United States;2. School of Medicine, Kansas City University, United States;3. Quality Improvement and Surgical Equity Research (QISER) Center, United States;1. Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, the Netherlands;2. Trauma Unit, Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands;3. Department of Forensic Medicine, Public Health Service of Amsterdam, the Netherlands |
| |
| Abstract: | BackgroundThe effects of palliative care (PC) consultation on patient costs and hospitalization metrics in the adult trauma population are unclear.Study DesignWe interrogated our Level I trauma center databases from 1/1/19 to 3/31/21 for patients age ≥18 admitted to the trauma service. Patients undergoing PC consult were matched using propensity scoring to those without PC consultation based on age, admission Glasgow Coma Scale score, Injury Severity Score and Head Abbreviated Injury Scale. Total costs, total cost per day, hospital length of stay (LOS), ICU LOS, intubation days, discharge disposition, and rates of nephrology consultation and tracheostomy/feeding tube placements were compared.Results140 unique patients underwent PC consultation and were matched to a group not receiving PC consult during the same period. Median total costs in the PC cohort were $39,532 compared to $70,330 in the controls (p<0.01). Median costs per day in the PC cohort were $3,495 vs $17,970 in the controls (p<0.01). Median costs per ICU day in the PC cohort were $3,774 vs $17,127 in the controls (p<0.01). Mean hospital LOS (15.7 vs 7 days), ICU LOS (7.9 vs 2.9 days), and ventilator days (5.1 vs 1.5) were significantly higher in the PC cohort (all p<0.01). Rates of nephrology consultation (8.6 vs 2.1%, p = 0.03) and tracheostomy/feeding tube placements (12.1 vs 1.4%, p<0.01) were also higher in the PC group. Patients were more likely to discharge to hospice if they received a PC consult (33.6 vs 2.1%, p<0.01). Mean time to PC consult was 7.2 days (range 1 hour to 45 days). LOS post-consult correlated positively with time to PC consultation (r = 0.27, p<0.01).ConclusionExpert PC services are known to alleviate suffering and avert patient goal- and value-incongruent care. While trauma patients demand significant resources, PC consultation offered in concordance with life-sustaining interventions is associated with significant savings to patients and the healthcare system. Given the correlation between LOS following PC consult and time to PC consult, savings may be amplified by earlier PC consultation in appropriate patients. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
