Interdisciplinary palliative care services for cancer patients: Assessing quality of care and outcomes measures of successful intervention.

Abstract

127 Background: Interdisciplinary palliative care (IPC) services play a critical role in improving patient care by establishing goals of care and expectations, reducing unnecessary readmissions, and limiting the resource and economic costs associated with end-of-life care. Identifying factors that impact the likelihood of readmissions and measures that help facilitate the transition of patients to hospice care may reduce these costs. Methods: We retrospectively reviewed the demographics, clinical parameters, and outcomes of nearly 500 patient consultations performed by the IPC service at our institution between 2014-2016. Focusing on patients with cancer as the primary diagnosis, we evaluated factors that increased the risk of 6-month readmission, likelihood of transitioning to hospice, and documentation of code-status at time of discharge using Fisher’s exact test and student’s t-tests. Results: Among all patients evaluated by IPC, the median age at consultation was 79.2+/-14.7, and 56.3% are male. Advanced cancer was the most common primary diagnosis (45.5%), with median age 70.9+/-16.0, and 62.1% are male. The 6-month readmission rate among oncology patients (6.5%) was not significantly greater than observed in non-oncology patients (5.9%), P = 0.95, although it was significantly lower than in Medicare patients (~20% in 30 days). Shortness of breath (SOB) was the most common chief complaint (53.9%) on admission. Compared to other chief complaints, such as failure to thrive and frailty, SOB was not associated with increased readmission rates. Reduced readmission rates were strongly reduced with transition to hospice (p < 2.1x10-4) and Do-Not-Resuscitate code status (p < 0.04). Disposition to home at discharge (p < 8.01e-05) was significantly associated with 6-month readmission, as compared to discharge to hospice (0.8%) or SNF (15.0%). Female patients (9/74) were more likely to be readmitted as compared to males (4/132), p < 0.035. Conclusions: We identified multiple predictors of 6-month readmission in our retrospective cohort, which may help stakeholders to identify opportunities to reduce readmission rates for terminal cancer patients.