Impact of palliative care consultation on end-of-life care measures: A retrospective analysis of patients in the Oncology Care Model.

Abstract

45 Background: Despite a 2016 ASCO recommendation that patients with advanced cancer receive dedicated palliative care (PC) services, many patients are not referred and continue to receive chemotherapy and utilize high-acuity services near the end of life (EOL). Studies suggest that early PC involvement is associated with lower spending, acute care utilization, and chemotherapy administration at the EOL. The Sidney Kimmel Cancer Center participates in the Oncology Care Model (OCM), a CMS episode-based alternative payment model promoting high-value care. Using OCM-generated data, we evaluated the effect of PC visits on EOL outcomes. Methods: We identified OCM patients with episodes starting April 1, 2016-July 1, 2018 with GI and head & neck malignancies who had died, and determined whether patients who saw a PC provider had greater documentation of a code status (CS) before death, as well as lower spending and utilization of chemotherapy or acute care in the last 30 days of life. CMS spending data and dates of death were derived from OCM quarterly feedback, while all other data was compiled via chart review. CS was recorded at the start of the episode and at the time of death. Results: The study included 126 patients (median age 66 years), of whom 38% had a PC visit. 24% had only an inpatient (IP) PC consult, 6% only an outpatient (OP) visit, and 9% both IP & OP visits. More patients who saw PC had an initial CS documented (85%, vs 46% for no PC), and had a greater proportional increase in CS documentation before death (96% vs 53%). Despite similar rates at baseline, the final CS was significantly more likely to be “Do Not Resuscitate/Intubate” (DNR/DNI) among PC patients (79%, vs 28% for no PC). An initial CS of DNR/DNI was associated with lower mean ICU and total non-hospice spending in the last 30 days of life. Conclusions: This retrospective study in OCM patients found that PC intervention is associated with improved documentation of a CS and higher rates of DNR/DNI documentation before death. There is an association between an initial DNR/DNI CS and lower acute care spending. This data suggests a beneficial effect of early PC on utilization at the EOL in advanced cancer patients.