Proof of the value of palliative care consultations
James M. Berklan
Everybody's looking for win-win scenarios, especially in healthcare. Because of such tight operating margins, that goes double for long-term care. That's what makes some of the newest palliative care research out of Brown University so intriguing.
Investigators there spent about three years in labor-intensive analysis to determine that palliative care consultations in nursing homes lead to less burdensome care, fewer rehospitalizations, better pain management and — get this — don't cost the system more.
That last part especially gets attention.
It turns out discussing preferences of care really does make a difference in patients' lives. People get their symptoms managed better, feel more in control and are ultimately subjected to less intensive treatments, which can have rippling positive effects.
Other care settings, such as hospitals, have confirmed this connection, but not nursing homes, said study corresponding author Susan Miller, Ph.D., a Brown University gerontologist and School of Public Health professor. Findings were released this week in the current issue of the Journal of the American Geriatrics Society.
Nursing homes don't have the same type of data available that hospitals do to more easily track palliative care consultations. Miller's team reverse-engineered their approach and went to the hospice provider to collect information.
They wound up studying records of about 1,500 former residents at 46 facilities in North Carolina and Rhode Island.
The study provides “the first empirical evidence of the value of palliative care consultations provided in [nursing homes],” study authors wrote.
“If the government paid more for these, there would be more availability,” Miller told me Tuesday. “If there's more availability, especially with some of the constraints nursing homes have with staffing, this could bring extra help at no expense to them.”
While Miller isn't holding her breath for any quick infusion of government funding, she does argue that accountable care organizations and participants in bundled pay initiatives should want to incorporate the palliative care consults as much as possible.
Reduced rehospitalizations would be very good for everyone. It could also lead to lower rates of end-of-life acute care use and potentially messy care transitions. The earlier the consultations took place, such as in the 61- to 180-day period before death, the more effective they were, study authors added.
Researchers compared MDS records of residents who had consultations with residents who hadn't. That was one of the most exhausting parts of the research, Miller said.
She is hoping this initial National Institute on Aging-funded research is parlayed into a demonstration project or clinical trial where more states could take part and try to replicate findings.
“I expected to find lower rates of hospitalization, but the volume of the difference was really remarkable,” Miller said.
“Nursing homes that have access to palliative care consult providers in their areas should really try to collaborate with them,” she added.
A bigger study could lead to algorithms that could bring intervention protocols.
Miller says colleagues know that ACOs and other value-based services purchasers have learned on their own that the palliative care consultations help.
“It's a good way to better manage care,” she says.