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How do different hospitals in the U.S. structure hospice and palliative care services (eg, what resources are available and are they cost saving)?
Hi! Thanks for your question on hospice and palliative care services. In short, palliative care services save money and provide numerous benefits to the patient and family. Despite these benefits, the Center to Advance Palliative Care (CAPC) reports, "...Access to palliative care remains inadequate for millions of Americans living with serious illness despite continuing growth in the number of U.S. hospitals reporting palliative care programs." Below, you will find a deeper dive of my findings regarding benefits of the service, cost effectiveness, and the role surgeons play in the palliative process.
METHODOLOGY
I began by researching trusted sources, such as Forbes and Penn Medicine News, to determine the amount of money spent on end-of-life services in the United States vs. other countries. Additionally, these source provided a comparison on the number of deaths occurring in the hospital and the number of bed days during the last 6 months of life. I then expanded my research to include how hospitals set up and run a palliative care unit, as well as other benefits of such a service, such as increased dignity and psychosocial support. Finally, I scoured news articles and files regarding the role of surgeons in the palliative care process, as well as what the future looks like for these specialists.
OVERVIEW
The U.S. has the lowest number of deaths in the hospital at 22%, compared with over 50% in Belgium and Canada, over 38% in England, Germany, and Norway, and 29% in Norway. Despite having the lowest number of days spent in the hospital in the last 6 months of life, the U.S. admits more than 40% of patients who die with cancer to the hospital at some point in the last 6 months of life, indicating poor performance, especially in the area of high-technology interventions. "What [the United States does] well is few hospitalizations and few people actually dying in the hospital. What we need to do is focus on providing 'universal palliative care' to all dying patients as a default," states Arlotta.
COST-EFFECTIVENESS
According to Forbes, the United States spends approximately $18,500 per patient on hospital care in the last 6 months of life. This is comparison to $21,840 spent in Canada, $19,783 in Norway, $15,699 in Belgium, $9,342 in England, and $10,936 in the Netherlands.
"Keeping a patient on life support in an intensive care unit bed costs, at a minimum, $2,000-$4,000 per day and can run much higher depending on the patient’s condition, into hundreds of thousands a year." reports the Washington Post. It is estimated that palliative care obtained within 6 days of a hospital admission can save up to 14%, or $1,312 for the patient and their family. Furthermore, palliative care obtained within 2 days of an admission can save approximately 24%, or $2,280. In reference to an inpatient palliative care unit, Up To Date notes, "In one study, a dedicated palliative care unit reduced daily hospital costs by 74 percent compared with usual care patients." Another study indicated that palliative care consultation was directly associated with a $1,700 cost reduction per admission for patients who were discharged alive, and almost $5,000 per admission cost reduction for patients who died.
BENEFITS OF PALLIATIVE CARE
"The primary tenets of palliative care are symptom management; establishing and implementing care plans in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his or her care; psychosocial, spiritual, and practical support both to patients and their family caregivers; and coordination across sites of care." Palliative care serves not only to provide an increased level of dignity to the patient, but to alleviate stress on family members and strengthen relationships, help the patient achieve a sense of control, and consider available treatments with respect to their values and goals.
Key components of palliative care include psychosocial, spiritual, and bereavement support. Palliative care also works to address the needs of family members. For example, most caregivers report mild to moderate stress, increasing their own chances for serious illness and death. Additionally, caregivers must consider the financial strain. "The leading cause of personal bankruptcy in the United States is providing care for a seriously ill loved one, regardless of insurance status. Families support seriously ill Americans from their own savings at an estimated half a trillion dollars every year." Palliative care services concentrate not only on the needs of the patients, but those of the caregivers surrounding them, as well.
THE STRUCTURE OF HOSPITAL PALLIATIVE CARE UNITS
In 2000, there were 658 hospitals with 50 beds or more that offered palliative care services. This number increased to over 1,700 in 2012. In 2015, more than 67% of U.S. hospitals this size had palliative care programs. Almost 90% of large hospitals (300 beds or more) boast a palliative care program.
Palliative care consultation teams typically consist of physicians, nurses, social workers, chaplains, pharmacists, psychologists, and volunteers. In some cases, referral to an inpatient palliative care unit is necessary, such as patients who have symptoms that are difficult to control, advanced medical needs, or increased family distress. A growing number of hospitals and facilities are integrating a co-managment model. "Successful models for palliative medicine integration into the intensive care unit, and most recently, the surgical and trauma intensive care units exist in many hospitals."
Specifically, surgeons play a vital role in the palliative care process. Krouse notes that many palliative care issues do not become apparent until the patient is in the operating room. Therefore, surgeons and surgical sub-specialists must be prepared, and have the clinical and communication skills necessary to deal with such situations. Complex issues may exist in palliative care that require a surgical specialist, such as wound care issues or malignant ascites. "A surgeon’s background adds great depth to their ability to treat the whole patient," states Krouse. According to Krouse, the most reasonable role for surgeons in the future would be to serve as a member of the interdisciplinary palliative care team.
CONCLUSION
To wrap it up, there are clearly many benefits of palliative care services. "Palliative care increases patient and family satisfaction, it improves quality and it has been shown to help to extend survival. The resulting cost savings are an unintended but welcome consequence of providing high quality care." Thank you for using Wonder! Please let us know if we can assist with anything else!