Impact of Palliative Care Case Management on Resource Use by Patients Dying of Cancer at a Veterans Affairs Medical Center

Abstract

The VA Puget Sound Health Care System (VAPSHCS) started a palliative care service (PCS) in October 2001 to provide case management for patients with advanced cancer. To examine resource use during the last 60 days of life for patients dying of cancer who received PCS compared to patients receiving usual care (non-PCS) during the same time period. Retrospective nonrandomized comparison of resource use using administrative data. Tertiary care Veterans Affairs medical center. All patients who died of cancer between October 1, 2001 and October 31, 2002 at VAPSHCS. Two hundred sixty-five patients died of cancer during the specified time period, including 82 PCS and 183 non-PCS patients. PCS patients received case management for a mean of 79 days, and were younger, had more comorbid conditions, and were more likely to have had chemotherapy in the last 60 days of life than non-PCS patients. Variables associated with more acute care bed days in the last 60 days of life included: chemotherapy in the last 60 days of life, and a length of stay on PCS less than 60 days. Variables associated with fewer acute care bed days within the last 60 days of life included: being married, and a length of stay on PCS 60 days or more. Compared to non-PCS patients, the place of death for PCS patients was less likely to be acute care. PCS for 60 or more days prior to death was associated with decreased use of acute care hospital resources for patients dying of cancer.