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J Palliat Med ; 16(3): 289-94, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23343113


BACKGROUND: Evidence suggests palliative care consult services yield cost improvements; few studies have examined the impact of an inpatient palliative care unit on hospital costs. OBJECTIVE: This study estimates the cost avoidance of a single hospital's acute palliative care unit (APCU), building upon previous studies (1) by limiting pre-APCU costs to two days pre-APCU transfer, thereby minimizing bias from higher-cost first days of admission, and (2) by not limiting the study to cancer patients or patients who died, thereby presenting more comprehensive APCU costs. DESIGN: This retrospective study compares direct costs of care on an APCU with costs pre-APCU transfer from general medical units, intensive care units (ICU), and the emergency department (ED), and compares the direct costs of APCU patients with those of control patients. The data were entered into an SPSS(®) 17.0 (SPSS Inc., Chicago, IL) statistical software database. Paired and independent samples t-tests were conducted to test cost differences. SETTING/SUBJECTS: Study patients were admitted or transferred to the APCU from October 2008 through January 2009. Control patients were inpatients during the same time period and met several matching criteria. MEASUREMENTS: The hospital's finance department provided direct costs, case mix index (CMI), and geometric mean length of stay, and the Department of Quality and Resource Management provided patients' demographic and administrative data. RESULTS: Of 209 patients transferred to the APCU, 50% transferred from a medical unit, 32% from an ICU, and 18% from the ED. Annualized, the total cost avoidance realized by transfers to the APCU was $848,556, over half of which came from ICU to APCU transfers. CONCLUSIONS: Cost avoidance is realized when patients transfer to an APCU even when conservative pre-APCU cost measures are used and when patients with varying diagnoses and discharge outcomes are included. This study demonstrates a replicable methodology for estimating the financial impact of an APCU.

Costos de Hospital , Unidades Hospitalarias/economía , Cuidados Paliativos/economía , Anciano , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Atención Terciaria de Salud/economía
Am J Hosp Palliat Care ; 26(5): 376-83, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19571324


BACKGROUND: Helping families make end-of-life care decisions can be challenging for health care providers in an intensive care unit (ICU). Family meetings facilitated by palliative care consult services (PCCS) have been recommended and found effective for improving support for families in these difficult situations. These services can be improved with a deeper understanding of factors associated with emotional burden in the aftermath of end-of-life decision making. OBJECTIVE: This qualitative study seeks to provide a better understanding of family experiences and emotional burden surrounding end-of-life decision making. PARTICIPANTS AND METHODS: We conducted in-depth, semistructured interviews with 23 family members following the death of a loved one in the ICU. All participants had been involved in a PCCS-led family meeting concerning end-of-life decisions about their loved one. Methodology from grounded theory was used to analyze the content of transcripts and to build a theoretical model. RESULTS: From the perspective of the family, decision making at the end of life is described within a theoretical model of salient experiences that are relevant to families' emotional burdens. Three temporal stages were evident: (1) the illness experience, (2) decision making in the family meeting, and (3) the dying process. However, emotional burden in the form of lingering questions and resentment was more common when families reported having negative experiences during the final hospital stay. CONCLUSIONS: Supportive responsiveness from the PCCS for families who have experienced critical incidents or who have unanswered questions or resentment about treatment may be an important consideration to alleviate later emotional burden.

Costo de Enfermedad , Familia/psicología , Cuidado Terminal/psicología , Muerte , Toma de Decisiones , Emociones , Humanos , Unidades de Cuidados Intensivos , Encuestas y Cuestionarios
J Pain Symptom Manage ; 37(5): 873-83, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-18804945


The widespread need for palliative care has prompted the development of hospital-based palliative care consult services to provide a more interdisciplinary approach to managing advanced illness and end-of-life concerns. Establishing a successful consult service is a challenging task. This is a descriptive study of the development of a palliative care consult service (PCCS) within a non-profit, multi-hospital health system, and the five successful strategies used to optimize growth over the first five years. The PCCS is a mobile interdisciplinary team established to provide accessible, comprehensive end-of-life care and symptom management to patients with advanced illness within the health care system. Critical to its success, the team developed and maintained a database to document growth and ensure continuous quality improvement. A description of this database is provided, along with current performance outcomes. The program has prospered since its inception in 2002, with a 47% average annual growth over the first five years. The PCCS now averages 110 consults per month and has treated more than 3500 patients. This growth can be directly attributed to the five key strategies that have been used to plan, develop, and expand the program.

Eficiencia Organizacional , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Derivación y Consulta/organización & administración , Cuidado Terminal/organización & administración , Carga de Trabajo , Ohio