Financial impact of palliative care consultation in a public hospital.

BACKGROUND: Palliative care programs assist with prognostication, symptom control, and communication with patient and family. Hospitals often require financial justification for new programs Objective: Study the financial impact of the palliative care consultation (PCc) service in a public hospital. SETTING/SUBJECTS: From January to December 2005, 258 deaths occurred on the medicine service. Of those deceased patients, 116 were studied. DESIGN: Inclusion criteria were 50 or more years of age, length of stay (LOS) 3 days or more, admission to an internal medicine service, and death during that hospitalization. MEASUREMENTS: Charges, diagnosis-related groups (DRGs), DRG weights, and demographic variables were examined. RESULTS: Of the 116 deceased patients studied, 61 patients received a PCc, while 55 did not. Most patients had Medicare or Medicaid (82.8%). Both groups were similar in terms of demographic characteristics. Average LOS was 14.4 days for patients with a PCc versus 12.2 days for those without (p = 0.57). Median charges for the group without a PCc were $42,731, versus a median of $35,824 for those with a PCc. There was no significant variation of DRG weights within the same DRG. DRG weight was significantly positively correlated with charges. Both PCc and DRG weight were significant predictors of charges, with 36% of charges variability explained by PCc and DRG weight. CONCLUSIONS: PCc significantly reduced charges in adult patients who died during their last hospitalization, even though the average LOS was higher for those who received a PCc versus those who did not.

Topiramate in the treatment of neuropathic pain in patients with cancer.

INTRODUCTION: Neuropathic pain has been reported to affect 40%-50% of patients with cancer. PATIENTS AND METHODS: Consecutive patients selected from the outpatient/adult patient palliative care clinic of the Roudebush Veterans Affairs Medical Center and the Indiana University Palliative Clinic were reviewed. A verbal pain linear analogue assessment scale was used to assess neuropathic pain. Pain medication history was also reviewed in addition to percent pain relief. The following variables were extracted from the medical record: pain characteristics, location, cause, date of initiation of therapy, maximal tolerated dose, pain scores on the visit of optimal tolerated dose, other concurrent medications, number of months of pain before initiation of topiramate therapy, and total duration of topiramate therapy. Decrease in worst, best, and average pain was recorded, as were the development of any adverse effects. RESULTS: Of the 13 patients on second- and third-line therapy, 53.8% had >/= 30% decrease in worst pain; 69.2% had >/= 30% decrease in average pain, and 53.8% had >/= 30% decrease in best pain. Eight of 13 patients (61.5%) experienced adverse effects. Five patients discontinued (38.5%) topiramate because of adverse events. CONCLUSION: Because our retrospective study showed topiramate to be a beneficial second- and third-line therapy in patients with cancer who did not experience adequate pain control on previous regimens, further prospective studies are needed to establish this medication in the armamentarium of neuropathic cancer pain management.