By: Lisa Remington, President, Remington Health Strategy Group, and Publisher, The Remington Report
A study demonstrated that increased palliative care consultations for patients with advanced cancers is associated with substantial impact on 30-day readmission, administration of chemotherapy following discharge, hospice referral, and use of support services following discharge.
The study was published in the American Society of Clinical Oncology’s (ASCO) Journal of Oncology Practice by lead author Dr. Kerin Adelson, Assistant Professor of Medical Oncology at Yale Cancer Center and Chief Quality Officer and Deputy Chief Medical Officer for Smilow Cancer Hospital, and colleagues from Mount Sinai Health System.
" The study shows that rates of 30-day readmissions dropped to 18% among those who received the automatic palliative care consultation compared to 35% in the control group."
This is the first study of its kind to demonstrate these significant results, and it is expected that expansion of this model to other hospitals and health systems should improve the value of cancer care. “Patients with advanced cancer admitted to an acute care hospital often have short life expectancies and high morbidity,” said Dr. Adelson. “For these patients, the integration of palliative care has improved symptom burden, reduced patient and caregiver distress, increased referral to hospice, and improved outcomes.”
Details of the Study
Standardization has been shown to improve quality of care and reduce 30-day readmissions.
Patients on an inpatient solid tumor service received an "automatic" palliative care consultation when they met at least one of the following four criteria, or "triggers:"
- Had an advanced solid tumor
- Prior hospitalization within 30 days
- Hospitalization greater than seven days
- Active symptoms
Patients who met the criteria and triggered an automatic consultation received palliative care consultations 80% of the time vs. 39% among control subjects. Hospice referrals were greater among the intervention group (26%) compared to the control group (14%).
The study shows that rates of 30-day readmissions dropped to 18% among those who received the automatic palliative care consultation compared to 35% in the control group. While length of stay was unaffected, patients in the intervention group received less chemotherapy after discharge (18%) than the control subjects (44%).
In 2016, the American Society of Clinical Oncologists (ASCO) called for incorporation of palliative care into oncologic care for all patients with metastatic cancer. This study emphasizes the importance of this charge, and reiterates that patients with advanced cancer should receive dedicated palliative care services, early in their diagnosis, along with their treatment plan.