The Association Between Varying Levels of Palliative Care Involvement on Costs During Terminal Hospitalizations in Canada from 2012–2015 (F405C)

Abstract

1.Assess the association between inpatient palliative care and costs during a terminal hospitalization.2.Determine the relationship between inpatient palliative care and costs, stratified by disease trajectory, and Canadian province.3.Discuss the value of using varied levels of palliative care to assess relationship with costs rather than dichotomous predictors of receiving palliative care vs. not. Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. Canadian adults (age ≥18 years) who died in hospital between April 1, 2012, and March 31, 2015 (N=250,640). Level of palliative care involvement defined as: medium-high, low, or no palliative care. Acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n (%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1,359 (95% CI 1,323: 1,397) (no involvement), $1,175 (95% CI 1,146: 1,206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). We observed an inverse dose-response relationship between palliative care involvement and costs.