Outpatient Palliative Care: Does It Matter? (763)

Abstract

1.Participants will discuss the current status of outpatient palliative care in the literature.2.Participants will describe the process for establishing, staffing, and monitoring the service needs and costs of patients referred to an outpatient palliative care clinic.3.Participants will critique cost evaluations and consider additional methods and measures for assessing cost impact. Outpatient palliative care continues to evolve with scant description in the literature; few studies present patient outcomes and no studies present system outcomes. Summa’s Hospice and Palliative Care Services opened an outpatient palliative care clinic (OPPCC) in January 2008. The purpose of this study is to retrospectively describe the population and measure the OPPCC’s system impact through pre vs. post OPPCC visit and OPPCC patient vs. control group cost analyses. OPPCC patients and matched controls seen between 1/1/2008 – 6/30/2010 were identified through electronic health records (EHR). Control patients were matched on age within 10 years and primary diagnosis. An EHR chart review identified primary diagnosis, up to 5 co-morbidities, source of referral, and primary care physician (PCP), number of PCP and urgent office visits. The number of Emergency Department (ED) visits, hospitalizations, and total hospital length of stay during the study period were obtained from the hospital’s EHR. The hospital’s finance department provided cost data for ED visits and hospitalizations. Data were analyzed using SPSS© paired samples and independent groups t-tests. The OPPCC saw 88 patients; complete data were available for 83 patients. The majority of patients (64.8%) had cancer. Mean patient costs for ED and inpatient care 6 months pre-OPPCC visit were $13,612 and mean costs 6 months post visit were $8,518 (P < 0.021); a mean cost reduction of $5,094 or 37.4% per patient. Identification of at least 50 controls is in progress. An OPPCC appears to have a significant impact in reducing healthcare costs for patients with advanced and complex illness. Thus comprehensive outpatient care that includes palliative medicine for such patients is an essential component of effective and efficient primary care.