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Achieving Value Through Palliative Care

By: Allison Silvers, MBA, Stacie Sinclair, MPP & Diane E. Meier, MD, FACP

DataGen was recently featured in an article from AJMC.com:

MOVING TO VALUE IN HEALTHCARE MEANS improving the quality of care delivered and the outcomes achieved while reducing unnecessary spending. Most healthcare organizations are pursuing value and the benefits that accrue under value-based payment, but too few are turning to palliative care to help achieve these goals.

Palliative care—which focuses on relieving the pain, symptoms, and stresses of a serious illness—changes healthcare delivery for both patients and their caregivers. Multiple studies and meta-analyses have shown that not only does palliative care improve patient experience and satisfaction,1-3 but that it also reduces emergency department (ED) visits, hospitalizations, and days spent in intensive care,4,5 thus reducing total spending.6,7 It does this through:

  • Safe and effective techniques for managing pain, shortness of breath, and other symptoms which would otherwise lead to ED and inpatient hospital use
  • Communication expertise needed for long, often difficult discussions with patients and families about prognosis, goals of care, and the patient’s wishes and values.

These skills and expertise benefit both the patients and the healthcare system. Standardized access to palliative care for hospitalized patients with advanced cancer has been shown to significantly reduce receipt of chemotherapy after discharge, as well as oncology service mortality and 30-day readmission rates.8 However, the most effective results are produced when palliative care is introduced early in the disease trajectory and is provided concurrent with treatment. For example, randomized controlled trials involving patients with cancer found that early and concurrent palliative care: • Results in a dramatic reduction in major depression (16% vs 38%)9

  • Increases survival by an average of nearly 3 months9
  • Results in fewer hospital admissions (33% vs 66%), fewer ED visits (34% vs 54%), reduced intensive care unit (ICU) use (5% vs 20%), and lower direct costs of inpatient care in the last 6 months of life ($19,067 vs $25,754).10

A recent analysis by DataGen found that oncology episodes for cancer of the esophagus, liver, pancreas, lung, testes, and brain have the greatest likelihood of hospital admission and ED visits.11 Not surprisingly, this list correlates with cancer types that report the greatest prevalence of pain12— patients and families turn to emergency services when symptoms are poorly managed. Yet expert palliative care mitigates the need for crisis intervention, thus simultaneously improving patient quality of life and cost-effectiveness.

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