Outpatient Cardiac Palliative Care Reduces Healthcare Utilization

Abstract

The American Heart Association and American Stroke Association have put forth statement recommending early and continuous access to palliative care for patients with heart disease. There is a national shortage of palliative care providers, and often outpatient palliative care clinics are not profitable to institutions with billing alone. However, early integration of palliative care has been proven to improve the quality of life of patients with advanced heart failure. Other studies have suggested that general palliative care has cost savings to hospital systems. A cardiac specific outpatient palliative care clinic was opened at a major academic medical center in the United States. In the first 6 months (N=104) patients were referred to the clinic for goals of care and symptom management. Patients were seen by a palliative care physician and registered nurse and screened for quality of life with the FACIT-Pal, HADS anxiety and depression screening, and Fried Frailty Assessment to guide clinical interventions. Patients were tracked 90 days prior to their initial outpatient palliative care clinic visit and 90 days post visit to assess hospital utilization and total cost of care in the university hospital system. Total hospitalizations reduced 30% (91 prior to palliative care compared to 64 post). 30-day readmission dropped by 11%. 36% (N=33) of pre-intervention hospitalizations were 30-day readmissions compared to 25% (N=16) in the post intervention time period. Total per-patient hospital system health expenditures were $121,549 pre-palliative intervention and reduced to $60,857 post-palliative intervention. This represents a total reduction in health spending of $5,886,599.51 in the post palliative care time period. Average per hospital stay cost dropped by 27% from $133,571 to $97,943. A paired T-test shows this is a statistically significant reduction in per hospital stay charges (p=0.03). Outpatient palliative care is known to improve quality of life in patients with advanced heart disease. Integration of outpatient cardiac palliative care reduces hospitalizations, 30-day readmission, total healthcare expenditures, and reduces cost of hospitalizations. Therefore, cardiac palliative care clinics are high value entities for patients and healthcare systems and teams should consider subsidizing the cost of palliative care clinic development.