Palliative Care Consultation Outside the Hospital

Summary and Comment |
November 23, 2016

Palliative Care Consultation Outside the Hospital

  1. Allan S. Brett, MD

Home-based and nursing home–based palliative care interventions were associated with fewer hospitalizations near the end of life.

  1. Allan S. Brett, MD

Traditionally, we think of palliative care consultation as an inpatient activity. However, it is increasingly becoming available in nonhospital settings. In a retrospective study, researchers evaluated a home-based palliative care program implemented by a San Diego healthcare system. Nearly 400 patients (age, mostly >80) with advanced cancer, chronic obstructive pulmonary disease, heart failure, or dementia who were enrolled in the program were compared with 1075 propensity-matched controls who were not enrolled. Initially, enrollees received four to six home visits weekly by nurses, as well as several social worker visits; subsequently, home visits were less frequent but were supplemented with regular phone contact. The proportion of patients hospitalized during the last month of life was markedly lower for palliative care participants than for controls (~20% vs. ~70%). Compared with controls, net monthly per-patient healthcare costs during the last 6 months of life in palliative care patients were lower by $2700 to $4300 (depending on the patient's underlying chronic disease).

In another retrospective study, researchers evaluated palliative care consultation for 477 nursing home residents who died during the study period; outcomes were compared with those of 1174 propensity-matched controls. Hospitalizations and emergency room visits during the last 6 months of life were significantly lower in the palliative care group (by about one third to one half, depending on the interval between palliative care consultation and the patient's death).

Comment

In these studies, bringing palliative care consultation to patients' homes or nursing homes was associated with lower rates of hospitalization and emergency room visits near the end of life. Assuming these objectives can be accomplished with either neutral or positive effects on patients' comfort and quality of life, home-based and nursing home palliative care programs should expand. Note that these programs are not the same as hospice; thus, patients were not required to have a life expectancy of less than 6 months.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

Dr.Bodepudi Narasimha Rao Other Healthcare Professional, Other, AIIMS-Bhubaneswar

We are running a palliative care clinic....and this may be of great help to us.

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