PCN97 - ASSESSING THE IMPACT OF ACTIVE IDENTIFICATION OF PATIENTS APPROPRIATE FOR PALLIATIVE CARE ON RESOURCE UTILIZATION AND COSTS IN THE FINAL MONTH OF LIFE

Abstract

This study aims to evaluate whether an active intervention to identify patients eligible for a palliative approach changes use of healthcare resources and costs within the final month of life. Between 2014 and 2017, physicians systematically identified 1,187 patients who were likely to die within one year and would benefit from early initiation of palliative care. Using propensity score matching, patients in this intervention group were 1:1 matched to non-intervention controls selected from publically-funded provincial administrative data. We compared healthcare resource utilization and costs (in 2017 Canadian dollars) within 30 days prior to death between 629 patients who died within the one-year follow-up and their 629 matched controls. Intervention and control groups were well-balanced in socio-demographics, comorbidities, and previous healthcare utilization. In the last 30 days of life, there was no difference in the proportion of patients who had any emergency department visit, intensive care unit admission, inpatient hospitalization, or opioid dispensation between two groups. However, patients in the intervention group had significantly higher use of palliative services (92.8% vs. 88.4%, p=0.007) and fewer hospitalizations without a palliative component (13.0% vs. 18.1%, p=0.013). In the 507 matched pairs with cancer, more patients in the intervention group underwent chemotherapy (12.0% vs. 6.3%, p=0.002) and palliative radiation (18.7%, vs. 13.2%, p=0.043). The mean cost-per-patient was $17,231 (95% CI 16,027, 18,436) for the intervention group and $16,951 (95% CI 15,899, 18,004) for controls. The dominant cost driver was inpatient hospitalizations in both groups. The intervention group had significantly higher mean drug ($624 vs. $467, p=0.004) and home health service ($1750 vs. $1476, p=0.02) costs. Routine active identification of palliative care patients does not significantly change overall costs of care, but suggests more appropriate resource and cost distribution for patients in the final month of life.