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Hospital-based palliative care may reduce ICU use
The implementation of hospital-based palliative care services was associated with a modest decrease in ICU use during terminal hospitalizations in New York, according to a study published in JAMA Network Open.
The study, which included 51 hospitals in New York and 73,370 adults who died during a terminal hospitalization, sought to determine whether implementation of hospital-based palliative care services affected ICU use at the end of life. Of the patients included in the study, about half were treated in hospitals that implemented palliative care services and half were treated in hospitals that did not.
Results showed that the likelihood of receiving intensive care was lower among patients who received care in hospitals after implementation of palliative care services than patients who received care in those same hospitals before implementation (49.3% vs. 52.8%; P < .001). Moreover, when compared with hospitals that never had a palliative care program, the implementation of palliative care was associated with a 10% reduction in ICU use during terminal hospitalizations (adjusted RR = 0.9; 95% CI, 0.85-0.95).
Additionally, in a subgroup of 10,177 critically ill patients with metastatic cancer, implementation of hospital-based palliative care was linked to a significant reduction in ICU use during terminal hospitalizations (aOR = 0.76; 95% CI, 0.65-0.88).
However, hospital-based palliative care was not associated with significant differences in hospital length of stay or use of dialysis or with ICU days or use of mechanical ventilation for patients admitted to the ICU in the overall population or in the subgroup of patients with metastatic cancer.
“Although the observed difference was small (absolute decrease of 3.5%), on a population level, the association may be magnified,” the researchers wrote, noting that hospitalization costs are approximately $2,703 higher for patients who do vs. those who do not use the ICU during a terminal hospitalization.
“Although this provides some understanding of the implications of palliative care implementation for the U.S. health care system, it is important to qualify that these data should not be taken to mean that decreasing ICU use would result in higher value care. Given that ICU use at the end of life is common, and recent studies question whether quality care at the end of life should be equated with less-intense care, it may be that the ICU does provide value to patients and families in a manner that is incompletely understood,” the researchers wrote.
They concluded that future studies “should focus on identifying characteristics associated with the effectiveness of palliative care programs in decreasing treatment intensity.” – by Melissa Foster
Disclosures: The authors report no relevant financial disclosures.