In-hospital hospice units: a novel approach to care in the final days
1
In-hospital hospice units: In-hospital hospice units: a novel approach to care in a novel approach to care in the final days the final days Introduction: The evidence for hospice’s ability to improve the patient and family’s quality of life and care is strong, and the evidence for its ability to reduce costs as a side effect is encouraging. Hospice is growing in popularity, though it remains primarily a home-based and outpatient service. To address the needs of the roughly third of Americans who die in hospitals our health system partnered with a local third-party hospice to open two inpatient hospice units (IPUs): an eight-bed unit at our flagship academic medical center (AMC-1) and a six-bed unit at an affiliated AMC (AMC-2). These units are able to serve patients transferred directly from the hospitals’ Emergency Departments (ED), intensive care units (ICU), or other inpatient units and provide a more supportive and less resource-intensive environment for the patient and family’s final days. Objectives: Describe the patients utilizing these units during their first full year of operation Quantify the costs and bed-days avoided by the hospital system Methods: A list of IPU patient admissions for CY 2011 was obtained from the hospice administrator’s inpatient census. We included patients 18 and older who expired were discharged from a floor unit, ICU, or the ED to the IPUs and subsequently expired. Data included demographics, death dates, costs and discharge locations abstracted from hospital and hospice records. In assessing costs we used the average daily total cost of patients who died in the hospital in CY2011. Palliative care (PC) consults were identified from clinic billing records. To test differences between the two hospitals we used 2- sample t-tests for continuous (LOS was log-transformed) and Chi-square tests for categorical variables. Results (Cont’d): African-Americans comprised 48.1% of IPU deaths vs. 49.2% of all hospital deaths; this suggests good utilization by African-Americans, who are historically poor utilizers of hospice Our IPUs are unique in that they can care for critical care patients; two-thirds of patients were transferred from the ICU Almost 10% of deaths were transferred directly from the ED, avoiding hospital admission entirely Two hospitals avoided over $7 million in costs over one year with these IPUs Conclusions: IPUs are a feasible method for care in patients’ final days within the hospital, particularly for high-acuity patients who could not otherwise be discharged Follow-up studies comparing quality and costs for IPU patients and those dying in other hospital units are needed Sources: Candy, B et al. “Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence.” Int J Nursing Stud. 2011; 48: 121-33. Brumley R et al. “Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care.” J. Am. Geriatr. Soc., 2007; 55: 993–1000. Goodman, D et al. Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness. Dartmouth Atlas Project, Hanover, NH. Zhao, Y., and Encinosa, W. The Cost of End-of-Life Hospitalizations, 2007. HCUP Statistical Brief #81. 2009. Agency for Healthcare Research and Quality, Rockville, MD. Results: Zachary O. Binney 1 , MPH Candidate, Epidemiology ([email protected]) Paul L. Desandre 1,2,3 , DO ([email protected]); Tammie E. Quest 1,2,3 , MD ([email protected]) 1 Emory Palliative Care Center; 2 U.S. Department of Veterans Affairs Medical Center; 3 Emory University School of Medicine, Department of Emergency Medicine ED or Inpatient (ICU/Floor units) From ED: Admission Avoided IPU Figure 1. The IPUs are physically co-located within the four walls of the hospital but administratively separate. They are staffed by faculty from the health system. From Inpatient: Discharge Transfer Characteristic Total (N=640) AMC-1 (N=413) AMC-2 (N=227) Age, years; Mean (SD) 68.4 (15.6) 68.6 (15.6) 68.0 (15.5) Gender (% Female) 55.6 53.8 59.0 Race, %* White 45.6 59.1 23.7 Insurance, %* Medicare/Medicaid 74.8 70.7 82.3 Commercial / Managed Care 18.4 21.3 13.2 Primary Hospice Diagnosis, %* Cancer 29.4 31.7 25.1 Respiratory Failure 25.5 22.0 31.7 Stroke 15.8 19.9 8.4 Heart Disease/Failure 10.5 10.2 11.0 Discharge Unit Type ICU 63.9 61.7 67.8 ED 8.1 9.2 6.2 Palliative Care Consult, % Yes* 90.2 94.7 81.9 Hospital LOS, Days; Mean (Range)* 10.2 (1-93) 9.4 (1- 92) 11.7 (1- 80) IPU LOS, Days; Mean (Range)* 4.1 (1- 28) *p<0.05; SD = Standard Deviation Table 1. Characteristics of Patients Expiring in the IPUs of an AMC and Tertiary Community Hospital, January-December 2011 (N=640). N Mean IPU LOS Total Hospital Days Avoided Costs Per Hospit al Day Costs Avoided 64 0 4.1 2,624 $2,901 $7,611, 122 Table 2. Cost Impact for Hospitals of Patients Successfully Transferred to IPU (N=640). EMORY UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF EMERGENCY MEDICINE
description
In-hospital hospice units: a novel approach to care in the final days. Introduction: - PowerPoint PPT Presentation
Transcript of In-hospital hospice units: a novel approach to care in the final days
In-hospital hospice units: a In-hospital hospice units: a novel approach to care in the novel approach to care in the
final daysfinal days
Introduction:The evidence for hospice’s ability to improve the patient and family’s quality of life and care is strong, and the evidence for its ability to reduce costs as a side effect is encouraging. Hospice is growing in popularity, though it remains primarily a home-based and outpatient service. To address the needs of the roughly third of Americans who die in hospitals our health system partnered with a local third-party hospice to open two inpatient hospice units (IPUs): an eight-bed unit at our flagship academic medical center (AMC-1) and a six-bed unit at an affiliated AMC (AMC-2). These units are able to serve patients transferred directly from the hospitals’ Emergency Departments (ED), intensive care units (ICU), or other inpatient units and provide a more supportive and less resource-intensive environment for the patient and family’s final days.
Objectives:Describe the patients utilizing these units during their first full year of operation Quantify the costs and bed-days avoided by the hospital system
Methods:A list of IPU patient admissions for CY 2011 was obtained from the hospice administrator’s inpatient census. We included patients 18 and older who expired were discharged from a floor unit, ICU, or the ED to the IPUs and subsequently expired. Data included demographics, death dates, costs and discharge locations abstracted from hospital and hospice records. In assessing costs we used the average daily total cost of patients who died in the hospital in CY2011. Palliative care (PC) consults were identified from clinic billing records. To test differences between the two hospitals we used 2-sample t-tests for continuous (LOS was log-transformed) and Chi-square tests for categorical variables.
Results (Cont’d):African-Americans comprised 48.1% of IPU deaths vs. 49.2% of all hospital deaths; this suggests good utilization by African-Americans, who are historically poor utilizers of hospiceOur IPUs are unique in that they can care for critical care patients; two-thirds of patients were transferred from the ICUAlmost 10% of deaths were transferred directly from the ED, avoiding hospital admission entirelyTwo hospitals avoided over $7 million in costs over one year with these IPUs
Conclusions:IPUs are a feasible method for care in patients’ final days within the hospital, particularly for high-acuity patients who could not otherwise be dischargedFollow-up studies comparing quality and costs for IPU patients and those dying in other hospital units are needed
Sources:Candy, B et al. “Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence.” Int J Nursing Stud. 2011; 48: 121-33.Brumley R et al. “Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care.” J. Am. Geriatr. Soc., 2007; 55: 993–1000.Goodman, D et al. Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness. Dartmouth Atlas Project, Hanover, NH. Zhao, Y., and Encinosa, W. The Cost of End-of-Life Hospitalizations, 2007. HCUP Statistical Brief #81. 2009. Agency for Healthcare Research and Quality, Rockville, MD.
Results:
Zachary O. Binney1, MPH Candidate, Epidemiology ([email protected])Paul L. Desandre1,2,3, DO ([email protected]); Tammie E. Quest1,2,3, MD ([email protected])
1Emory Palliative Care Center; 2U.S. Department of Veterans Affairs Medical Center; 3Emory University School of Medicine, Department of Emergency Medicine
ED or Inpatient (ICU/Floor units)
From ED: Admission Avoided
IPU
Figure 1. The IPUs are physically co-located within the four walls of the hospital but administratively separate. They are staffed by faculty from the health system.
From Inpatient: Discharge
Transfer
CharacteristicTotal
(N=640)
AMC-1 (N=413
)
AMC-2 (N=227)
Age, years; Mean (SD)
68.4 (15.6)
68.6 (15.6) 68.0 (15.5)
Gender (% Female) 55.6 53.8 59.0Race, %* White 45.6 59.1 23.7
Insurance, %* Medicare/
Medicaid 74.8 70.7 82.3 Commercial / Managed Care 18.4 21.3 13.2Primary Hospice Diagnosis, %*
Cancer 29.4 31.7 25.1Respiratory
Failure 25.5 22.0 31.7Stroke 15.8 19.9 8.4
Heart Disease/Failure 10.5 10.2 11.0Discharge Unit Type
ICU 63.9 61.7 67.8ED 8.1 9.2 6.2
Palliative Care Consult, % Yes* 90.2 94.7 81.9Hospital LOS, Days; Mean (Range)*
10.2 (1-93)
9.4 (1-92) 11.7 (1-80)
IPU LOS, Days; Mean (Range)*
4.1 (1-28)
3.9 (1-28) 4.5 (1-23)
*p<0.05; SD = Standard Deviation
Table 1. Characteristics of Patients Expiring in the IPUs of an AMC and Tertiary Community Hospital, January-December 2011 (N=640).
NMean IPU LOS
Total Hospital
Days Avoided
Costs Per
Hospital Day
Costs Avoide
d
640
4.1 2,624 $2,901$7,611,
122
Table 2. Cost Impact for Hospitals of Patients Successfully Transferred to IPU (N=640).
EMORY UNIVERSITY SCHOOL OF MEDICINE
DEPARTMENT OF EMERGENCY MEDICINE
