Dedicated palliative care consults improve outcomes

Dec 19 2012

By Sarah Guy, medwireNews Reporter

Data from a long-term care facility in the USA indicate that a dedicated palliative care consult service results in a more favorable course of treatment and clinical outcomes for residents.

Specifically, the number of emergency room (ER) visits and the rate of depression both significantly decreased after the service was initiated, and reductions were also seen in the number of physician orders, medication use, hospital stays, and falls.

These outcomes will bring down the cost of expensive services in an era of healthcare that has been challenged with decreasing preventable hospitalization rates and providing more compassionate, coordinated, and patient-centered care, remark the researchers in The Gerontologist.

"The national health care crisis has created a mandate to cut costs while improving care for millions of aging Americans who would otherwise experience frequent hospitalizations and futile aggressive care in their last months," said lead author Jody Comart (Hebrew Rehabilitation Center, Boston, Massachusetts) in a media statement.

Comart and colleagues analyzed the effect of an interdisciplinary consult team formed at their institution to facilitate "goals-of-care" conversations and provide a "compassionate response to the pressing needs of residents and their families facing end-of-life challenges."

A total of 250 residents formed the study cohort, of whom 125 lived at the care facility while the palliative care service was active, and 125 lived there before it was initiated.

Overall, the composite outcome score decreased over the four quarters of the minimum data set while the palliative consult service was in use, indicating fewer physician orders, less medication use, fewer hospital stays and ER visits, a more favorable depression status, fewer falls, less pain, fewer pressure ulcers, less shortness of breath, and less weight loss.

The opposite trend was true for the comparison group without the palliative service, note Comart et al.

For patients treated under the palliative consult service, only the individual components of depression and ER visits improved to a statistically significant degree, and when the analysis was repeated without the factors under facility staff's control (ie, physician orders, number of medications, hospital and ER visits), the effect became nonsignificant.

This finding indicates that the magnitude of effect in the initial analysis is "in large part driven by ER visits," concludes the research team.

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