The implementation of hospital-based palliative care services in New York State was associated with a 10% decrease in intensive care unit (ICU) use during end-of-life care, according to a study published in JAMA Network Open.
“Our findings are in line with those of prior studies demonstrating that the use of palliative care consultation is associated with a decreased likelihood of patients’ dying in the ICU and shorter ICU stays for patients who died during hospitalization,” wrote the authors, led by May Wua, MD, from the Department of Anesthesiology at Columbia University College of Physicians and Surgeons, New York City.
The study included 51 New York State hospitals: 24 hospitals that implemented a program of hospital-based palliative care between 2008 and 2014 and 27 hospitals that did not. Data were collected using a statewide Planning and Research Cooperative System, and information about palliative care programs came from the National Palliative Care Registry from 2008 to 2013. Analyses were performed between January 2019 and July 2019.
During the study period, a total of 73,370 terminal patients died while hospitalized: 37,628 patients who received care in hospitals that implemented palliative care and 35,742 who received care in a hospital without implementation. For patients in the implementation hospitals, 17,146 received care before implementation and 20,482 received care after implementation.
The primary outcome was receipt of intensive care; patients with intermediate ICU charges were not classified as receiving intensive care. Secondary outcomes included hospital length of stay, use of dialysis, days in the ICU, and use of mechanical ventilation for patients admitted to the ICU during their hospitalization.
Admission to an ICU during a terminal hospitalization was frequent, noted the researchers. Patients admitted after implementation of hospital-based palliative care were less likely to receive intensive care than patients admitted before implementation. 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. The implementation of hospital-based palliative care was not associated with significant differences in hospital length of stay, use of dialysis, ICU days, or use of mechanical ventilation.
“Although the observed difference was small (absolute decrease in ICU stay of 3.5%), on a population level, the association may be magnified,” noted the researchers. “With these estimates, a decrease in ICU use of 3.5% would translate to a difference in cost of approximately $265 million [annually].”
The findings of the study suggest that the availability of palliative care may also reduce stress of end-of-life care for both patients and their loved ones. “Less-medicalized death has been associated with higher ratings of quality of life, quality of death, and quality of end-of-life care and fewer psychological symptoms in bereaved caregivers, particularly for patients with advanced cancer,” the authors concluded.
Hua M, Lu Y, Ma X, Morrison RS, Li G, Wunsch H. Association between the implementation of hospital-based palliative care and use of intensive care during terminal hospitalizations. JAMA Netw Open. 2020;3(1):e1918675.