A pilot study on patient-related costs and factors associated with the cost of specialist palliative care in the hospital: first steps towards a patient classification system in Germany

Christian Becker,Reiner Leidl,Eva Schildmann,Claudia Bausewein,Farina Hodiamont

doi:10.1186/s12962-018-0154-3

Abstract

BackgroundSpecialist palliative care in the hospital addresses a heterogeneous patient population with complex care needs. In Germany, palliative care patients are classified based on their primary diagnosis to determine reimbursement despite findings that other factors describe patient needs better. To facilitate adequate resource allocation in this setting, in Australia and in the UK important steps have been undertaken towards identifying drivers of palliative care resource use and classifying patients accordingly. We aimed to pioneer patient classification based on determinants of resource use relevant to specialist palliative care in Germany first, by calculating the patient-level cost of specialist palliative care from the hospital’s perspective, based on the recorded resource use and, subsequently, by analysing influencing factors.MethodsCross-sectional study of consecutive patients who had an episode of specialist palliative care in Munich University Hospital between 20 June and 4 August, 2016. To accurately reflect personnel intensity of specialist palliative care, aside from administrative data, we recorded actual use of all involved health professionals’ labour time at patient level. Factors influencing episode costs were assessed using generalized linear regression and LASSO variable selection.ResultsThe study included 144 patients. Mean costs of specialist palliative care per palliative care unit episode were 6542€ (median: 5789€, SE: 715€) and 823€ (median: 702€, SE: 31€) per consultation episode. Based on multivariate models that considered both variables recorded at beginning and at the end of episode, we identified factors explaining episode cost including phase of illness, Karnofsky performance score, and type of discharge.ConclusionsThis study is an important step towards patient classification in specialist palliative care in Germany as it provides a feasible patient-level costing method and identifies possible starting points for classification. Application to a larger sample will allow for meaningful classification of palliative patients.

Highlights

Specialist palliative care in the hospital addresses a heterogeneous patient population with complex care needs
This study involved 144 episodes of specialist palliative care that mostly involved patients with primary diagnoses related to cancer
Thereby, our unit costing approach differs from that developed by the Institute for Hospital Reimbursement (InEK) for routine use in hospitals participating in calculation of nationwide diagnosis related groups (DRG) cost weights in Germany, which calculates the sum of all resource use during a patient’s entire hospital stay for a given structure of cost centre and cost type [26]

Summary

Introduction

Specialist palliative care in the hospital addresses a heterogeneous patient population with complex care needs. In light of complex and widely varying needs, grouping clinically similar specialist palliative care patients who require a similar complexity of care is helpful for several reasons. This may help to understand the patients’ resource needs more comprehensively and establish a “common language” that simplifies communication among clinicians and between clinicians and administration. Patient classifications have been developed for palliative care in Australia and the UK [6,7,8] They exist in other health care fields such as inpatient care, outpatient care, and nursing home care, where different aspects are driving care, and it has long been recognized that classifications may not function adequately when used across health care settings [9]

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