Five criteria doubled palliative care, cut hospital readmissions

Using five characteristics doubled palliative care consults for patients with solid tumors in a small study at one facility. As a result, hospice utilization rates increased by more than 10% and 30-day readmission rates decreased from 36% to 17%, Dr. Kerin Adelson reported during a press briefing held in advance of the symposium on quality care sponsored by the American Society of Clinical Oncology, where the results of the pilot program will be presented in full.

The criteria used to prompt palliative care consults in patients with sold tumors are as follows:

• Stage IV disease.

• Stage III lung or pancreatic cancer.

• Prior hospitalization within 30-days, excluding routine chemotherapy.

• Hospitalization lasting longer than 7 days.

• Uncontrolled symptoms including pain, nausea/vomiting, dyspnea, delirium, and psychological distress.

"Too many patients receive palliative care too late or go without it altogether. This results in inadequate pain control, emotional distress for patients and caregivers, and overuse of aggressive medical interventions. By increasing access to palliative care services, we hoped to help patients clarify their own treatment goals and, in turn, align our clinical goals with those of our patients," said Dr. Adelson of Mount Sinai Hospital, N.Y.

Over 3 months, 68 patients at the center with solid tumors qualified for the palliative care consultations. The investigators compared outcomes for these patients with rates of palliative care for 51 patients during a 6-week period before the program was implemented.

Before the routine use of the criteria, 41% of the patients received a palliative care consultation. After the program was implemented, this rate doubled to 82% – a significant increase (P less than .0001). Thirty-day readmission rates fell from 36% before use of the criteria to 17% after use of the criteria – also a significant improvement (P = .022). Hospice utilization increased from 14% before to 25% after – a difference that was not statistically significant (P = .146).

The investigators also assessed data from the entire Mount Sinai University Health System Consortium, comparing outcomes during the pilot study to the averages seen within the system during the previous year.

Projecting results from the pilot study onto that data, about 60% of patients admitted with a solid tumor would have been eligible for a consult under the investigational criteria. The intervention would have reduced 30-day readmission rates from 22% to 13% and would have significantly lowered the mortality index – an inpatient death rate that controls for the severity of illness – from 1.39 to 0.59, according to Dr. Adelson.

"This means that fewer patients were dying in acute hospital settings than would be expected for the severity of illness," she said.

Before the five criteria were established, the facility had no guidelines and relied on the treating oncologist’s discretion for identifying patients who needed palliative care consults, said Dr. Adelson, who determined the criteria in collaboration with her Mount Sinai colleagues. Now, patients who meet any of the criteria are offered a palliative care consultation, which could lead to new symptomatic treatments or to hospice care at home or in the hospital.

The facility has now decided to create a palliative care team that will provide consultation for every patient who meets the new criteria, she added.

Dr. Adelson had no financial disclosures related to her presentation.

msullivan@frontlinemedcom.com

Using five characteristics doubled palliative care consults for patients with solid tumors in a small study at one facility. As a result, hospice utilization rates increased by more than 10% and 30-day readmission rates decreased from 36% to 17%, Dr. Kerin Adelson reported during a press briefing held in advance of the symposium on quality care sponsored by the American Society of Clinical Oncology, where the results of the pilot program will be presented in full.

The criteria used to prompt palliative care consults in patients with sold tumors are as follows:

• Stage IV disease.

• Stage III lung or pancreatic cancer.

• Prior hospitalization within 30-days, excluding routine chemotherapy.

• Hospitalization lasting longer than 7 days.

• Uncontrolled symptoms including pain, nausea/vomiting, dyspnea, delirium, and psychological distress.

"Too many patients receive palliative care too late or go without it altogether. This results in inadequate pain control, emotional distress for patients and caregivers, and overuse of aggressive medical interventions. By increasing access to palliative care services, we hoped to help patients clarify their own treatment goals and, in turn, align our clinical goals with those of our patients," said Dr. Adelson of Mount Sinai Hospital, N.Y.

Over 3 months, 68 patients at the center with solid tumors qualified for the palliative care consultations. The investigators compared outcomes for these patients with rates of palliative care for 51 patients during a 6-week period before the program was implemented.

Before the routine use of the criteria, 41% of the patients received a palliative care consultation. After the program was implemented, this rate doubled to 82% – a significant increase (P less than .0001). Thirty-day readmission rates fell from 36% before use of the criteria to 17% after use of the criteria – also a significant improvement (P = .022). Hospice utilization increased from 14% before to 25% after – a difference that was not statistically significant (P = .146).

The investigators also assessed data from the entire Mount Sinai University Health System Consortium, comparing outcomes during the pilot study to the averages seen within the system during the previous year.

Projecting results from the pilot study onto that data, about 60% of patients admitted with a solid tumor would have been eligible for a consult under the investigational criteria. The intervention would have reduced 30-day readmission rates from 22% to 13% and would have significantly lowered the mortality index – an inpatient death rate that controls for the severity of illness – from 1.39 to 0.59, according to Dr. Adelson.

"This means that fewer patients were dying in acute hospital settings than would be expected for the severity of illness," she said.

Before the five criteria were established, the facility had no guidelines and relied on the treating oncologist’s discretion for identifying patients who needed palliative care consults, said Dr. Adelson, who determined the criteria in collaboration with her Mount Sinai colleagues. Now, patients who meet any of the criteria are offered a palliative care consultation, which could lead to new symptomatic treatments or to hospice care at home or in the hospital.

The facility has now decided to create a palliative care team that will provide consultation for every patient who meets the new criteria, she added.

Dr. Adelson had no financial disclosures related to her presentation.

msullivan@frontlinemedcom.com

Using five characteristics doubled palliative care consults for patients with solid tumors in a small study at one facility. As a result, hospice utilization rates increased by more than 10% and 30-day readmission rates decreased from 36% to 17%, Dr. Kerin Adelson reported during a press briefing held in advance of the symposium on quality care sponsored by the American Society of Clinical Oncology, where the results of the pilot program will be presented in full.

The criteria used to prompt palliative care consults in patients with sold tumors are as follows:

• Stage IV disease.

• Stage III lung or pancreatic cancer.

• Prior hospitalization within 30-days, excluding routine chemotherapy.

• Hospitalization lasting longer than 7 days.

• Uncontrolled symptoms including pain, nausea/vomiting, dyspnea, delirium, and psychological distress.

"Too many patients receive palliative care too late or go without it altogether. This results in inadequate pain control, emotional distress for patients and caregivers, and overuse of aggressive medical interventions. By increasing access to palliative care services, we hoped to help patients clarify their own treatment goals and, in turn, align our clinical goals with those of our patients," said Dr. Adelson of Mount Sinai Hospital, N.Y.

Over 3 months, 68 patients at the center with solid tumors qualified for the palliative care consultations. The investigators compared outcomes for these patients with rates of palliative care for 51 patients during a 6-week period before the program was implemented.

Before the routine use of the criteria, 41% of the patients received a palliative care consultation. After the program was implemented, this rate doubled to 82% – a significant increase (P less than .0001). Thirty-day readmission rates fell from 36% before use of the criteria to 17% after use of the criteria – also a significant improvement (P = .022). Hospice utilization increased from 14% before to 25% after – a difference that was not statistically significant (P = .146).

The investigators also assessed data from the entire Mount Sinai University Health System Consortium, comparing outcomes during the pilot study to the averages seen within the system during the previous year.

Projecting results from the pilot study onto that data, about 60% of patients admitted with a solid tumor would have been eligible for a consult under the investigational criteria. The intervention would have reduced 30-day readmission rates from 22% to 13% and would have significantly lowered the mortality index – an inpatient death rate that controls for the severity of illness – from 1.39 to 0.59, according to Dr. Adelson.

"This means that fewer patients were dying in acute hospital settings than would be expected for the severity of illness," she said.

Before the five criteria were established, the facility had no guidelines and relied on the treating oncologist’s discretion for identifying patients who needed palliative care consults, said Dr. Adelson, who determined the criteria in collaboration with her Mount Sinai colleagues. Now, patients who meet any of the criteria are offered a palliative care consultation, which could lead to new symptomatic treatments or to hospice care at home or in the hospital.

The facility has now decided to create a palliative care team that will provide consultation for every patient who meets the new criteria, she added.

Dr. Adelson had no financial disclosures related to her presentation.

msullivan@frontlinemedcom.com