Hospital inpatient palliative care consultation services (PCCSs) provide high-quality, comprehensive care for seriously ill patients and their families. The objective of the Palliative Care Impact Study was to evaluate the impact of a PCCS in a rural Appalachian community hospital in 4 domains: clinical, customer, operational, and financial.
Methods and Results:
A nonrandomized preintervention–postintervention study enrolled 25 patients. We collected data in the 4 domains listed above after a palliative care (PC) consultation and compared them with preconsultation data. Findings demonstrated a statistically significant improvement in pain and symptom burden scores; customer metrics produced an excellent rating of 88.5% by patients and families and physician/providers; with an associated cost savings of $521 per patient per day after PC consultation was complete.
GrudzenC. At the end of life, sometimes less is more. Arch Intern Med. 2011;171(13):1201–1201.
2.
BakerRWuAWTenoJM. Family satisfaction with end-of-life care in seriously ill hospitalized adults. J Am Geriatr Soc. 2000;48(5 suppl):S61–S69.
3.
TenoJMClarridgeBRCaseyV. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):88–93.
4.
RiceEMBetcherDK. Evidence base for developing a palliative care service. Medsurg Nurs. 2007;16(3):143–148.
5.
A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274(20):1591–1598.
6.
MorrisonRSDietrichJLadwigS. Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood). 2011;30(3):454–463.
7.
WeissmanDEMeierDESpragensLH. Center to Advance Palliative Care palliative care consultation service metrics: consensus recommendations. J Palliat Med. 2008;11(10):1294–1298.
8.
WeiglG. Palliative care in the management of heart failure. Wien Med Wochenschr. 2008;158(23-24):739–744.
9.
CasarettDJohnsonMSmithDRichardsonD. The optimal delivery of palliative care: a national comparison of the outcomes of consultation teams vs inpatient units. Arch Intern Med. 2011;171(7):649–655.
10.
BrumleyREnguidanosSJamisonP. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007;55(7):993–1000.
11.
WrightAAZhangBRayA. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–1673.
12.
LorenzKALynnJDySM. Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med. 2008;148(2):147–159.
13.
MorrisonRSPenrodJDCasselJB. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–1790.
14.
AngusDCBarnatoAELinde-ZwirbleWT. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004;32(3):638–643.
The Dartmouth Institute for Health Policy and Clinical Practice. The Dartmouth Atlas of Health Care. 2011. www.dartmouthatlas.org. Accessed October 12, 2011.
18.
EdensPS HCGildenKM. Developing and financing a palliative care program. Am J Hosp Palliat Care. 2008;25(5):379–384.
19.
HutsonSPDorganKAPhillipsANBehringerB.The mountains hold things in: the use of community research review work groups to address cancer disparities in Appalachia. Oncol Nurs Forum. 2007;34(6):1133–1139.
20.
Van VorstRFCraneLABartonPLKutnerJSKallailKJWestfallJM. Barriers to quality care for dying patients in rural communities. J Rural Health. 2006;22(3):248–253.
21.
DorganKAHutsonSPGerdingGDuvallKL. Culturally tailored cancer communication, education, and research: the highways and back roads of Appalachia. Prev Chronic Dis. 2009;6(2):A68.
22.
BigbeeJLLindB. Methodological challenges in rural and frontier nursing research. Appl Nurs Res. 2007;20(2):104–106.
23.
RobinsonCAPesutBBottorffJLMowryABroughtonSFylesG. Rural palliative care: a comprehensive review [published online February 13, 2009]. J Palliat Med. 2009.
24.
KelleyMLHabjanSAegardJ. Building capacity to provide palliative care in rural and remote communities: does education make a difference?J Palliat Care. 2004;20(4):308–315.
25.
SchraderSLNelsonMLEidsnessLM.Palliative care teams on the prairie: composition, perceived challenges & opportunities. S D Med. 2007;60(4):147–149, 151–153.
26.
CasselJBWebb-WrightJHolmesJLyckholmLSmithTJ. Clinical and financial impact of a palliative care program at a small rural hospital. J Palliat Med. 2010;13(11):1339–1343.
27.
WeissmanDEMeierDE. Operational features for hospital palliative care programs: consensus recommendations. J Palliat Med. 2008;11(9):1189–1194.
28.
StielSPastranaTBalzerCElsnerFOstgatheCRadbruchL. Outcome assessment instruments in palliative and hospice care-a review of the literature [published online March 13, 2012]. Support Care Cancer. 2012.
29.
HerrKBjoroKDeckerS. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage. 2006;31(2):170–192.
30.
HigginsonIJFinlayIGGoodwinDM. Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?J Pain Symptom Manage. 2003;25(2):150–168.
CohenSRMountBMStrobelMGBuiF. The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med. 1995;9(3):207–219.
33.
KamalAHMaguireJMWheelerJLCurrowDCAbernethyAP. Dyspnea review for the palliative care professional: assessment, burdens, and etiologies. J Palliat Med. 2011;14(10):1167–1172.
34.
HeylandDKDodekPRockerG. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ. 2006;174(5):627–633.
35.
GelfmanLPMeierDEMorrisonRS. Does palliative care improve quality? A survey of bereaved family members. J Pain Symptom Manage. 2008;36(1):22–28.
36.
JonesJMMcPhersonCJZimmermannCRodinGLeLWCohenSR. Assessing agreement between terminally ill cancer patients’ reports of their quality of life and family caregiver and palliative care physician proxy ratings. J Pain Symptom Manage. 2011;42(3):354–365.
37.
DesbiensNAMueller-RiznerNConnorsAFJrWengerNSLynnJ.The symptom burden of seriously ill hospitalized patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcome and Risks of Treatment. J Pain Symptom Manage. 1999;17(4):248–255.
38.
O'MahonySBlankAEZallmanLSelwynPA. The benefits of a hospital-based inpatient palliative care consultation service: preliminary outcome data. J Palliat Med. 2005;8(5):1033–1039.
39.
SmithTJCasselJB. Cost and non-clinical outcomes of palliative care. J Pain Symptom Manage. 2009;38(1):32–44.
40.
BirksTKrikosDMcGowanCStoneP. Is there a need for weekend face-to-face inpatient assessments by hospital specialist palliative care services? Evaluation of an out-of-hours service. Palliat Med. 2011;25(3):278–283.
