Newswise, January 6, 2016--Patients with incurable cancer and
numerous other serious health conditions who consulted with a palliative care
team within two days of hospitalization had significant savings in hospital
costs, according to a new study led by researchers at the Icahn School of
Medicine at Mount Sinai.
Published in the January issue of the journal Health
Affairs, the study also determined that the higher number of serious
coexisting conditions patients had, the greater reduction in direct hospital
costs.
While previous studies have shown the link between palliative
care and lower costs, this is the first study to examine whether the effect of
palliative care consultation varies by the number of co-existing chronic
conditions.
Researchers compared a treatment group of advanced cancer
patients with numerous serious health conditions (also known as comorbidities)
from six hospitals who were seen by a palliative care team with a separate
group who received usual care.
Findings indicated that patients from the treatment group on
average had a 22 percent reduction in costs compared to the group that did not
receive palliative consultation.
Data showed that patients with the highest number of
comorbidities had up to a 32 percent reduction in costs. The study’s findings
suggest that early palliative consultations with the sickest patients may
decrease unwanted aggressive end-of-life care, as well as shorten length of
stays in hospital.
Palliative care is a team-based specialty (incorporating medicine, nursing, social work and chaplaincy) focused on improving quality of life for people with serious illnesses by adding a layer of support for patients, their families, and health care providers.
It is provided in conjunction with all other appropriate medical
treatments, including curative and life-prolonging therapies.
Programs using palliative care consultation teams have rapidly
expanded in recent years. Today, over 90 percent of medium-size to large U.S.
hospitals now have palliative care teams.
“We already know that coordinated, patient-centered palliative
care improves care quality, enhances survival, and reduces costs for persons
with cancer,” said R. Sean Morrison, MD, Director of the National Palliative
Care Research Center and Professor of Geriatrics and Palliative Medicine, Icahn
School of Medicine at Mount Sinai and lead author of the study.
“Our latest research now shows the strong association between
cost and the number of co-occurring conditions. Among patients with advanced
cancer and other serious illnesses, aggressive treatments are often
inconsistent with patients’ wishes and are associated with worse quality of
life compared to other treatments. It is imperative that policymakers act to
expand access to palliative care.”
Patients with multimorbidities account for a high proportion
of U.S. health care spending. They also comprise two-thirds of Medicare
beneficiaries and account for almost half of the program’s total spending.
According to the Centers for Medicare and Medicaid Services
(CMS), over the next decade, annual Medicare expenditures will increase by 98
percent and total annual national health spending will grow by 76 percent,
reaching $5.4 trillion.
Increasing access to palliative care during hospitalization
for patients with advanced cancer and multiple chronic conditions could both
improve care and help curb the growth of health care spending.
“The fact that we found greater cost savings for cancer
patients with more comorbidities than for those with fewer comorbidities raises
the question of whether similar results would be observed in patients with
other serious illnesses and multimorbidity,” said Professor Peter May of
Trinity College Dublin and a former visiting research fellow in the Department
of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount
Sinai and co-author of the study.
“Future research is also needed to determine when in the
course of illness palliative care is most cost-effective.”
The study was supported by the National Cancer Institute (NCI)
and the National Institute of Nursing Research. Additional collaborators
include researchers from Johns Hopkins University, Trinity College Dublin,
Virginia Commonwealth University and James J. Peters VA Medical Center.
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system
committed to providing distinguished care, conducting transformative research,
and advancing biomedical education. Structured around seven hospital campuses
and a single medical school, the Health System has an extensive ambulatory
network and a range of inpatient and outpatient services—from community-based
facilities to tertiary and quaternary care.
The System includes approximately 6,100 primary and specialty
care physicians; 12 joint-venture ambulatory surgery centers; more than 140
ambulatory practices throughout the five boroughs of New York City,
Westchester, Long Island, and Florida; and 31 affiliated community health
centers. Physicians are affiliated with the renowned Icahn School of Medicine
at Mount Sinai, which is ranked among the highest in the nation in National
Institutes of Health funding per investigator. The Mount Sinai Hospital is
ranked as one of the nation’s top 10 hospitals in Geriatrics, Cardiology/Heart Surgery,
and Gastroenterology, and is in the top 25 in five other specialties in the
2015-2016 “Best Hospitals” issue of U.S. News & World Report. Mount Sinai’s
Kravis Children’s Hospital also is ranked in seven out of ten pediatric
specialties by U.S. News & World Report. The New York Eye and Ear Infirmary
of Mount Sinai is ranked 11th nationally for Ophthalmology, while Mount Sinai
Beth Israel is ranked regionally.
For more information, visit www.mountsinai.org or
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