Center to Advance Palliative Care

Hi. You may have solved all your problems in the past couple of months but if not here are some thoughts. First, regarding impect on total LOS: published literature indicates no effect of PC consults on total LOS, and this is terribly difficult to try to assess using retrospective analyses. However several studies do demonstrate impact on ICU days and you can simply assess how many of your consults were in the ICUs, how many pts transferred out of ICU to acute beds, and how many days did they then stay in those acute beds before death or discharge and use that as a sum of ICU impact days. Second, regarding actual methods for demonstrating cost avoidance, we recommend two steps (and not any DRG-to-DRG comparisons). 1) Take those patients you consulted, determine average direct cost per day in 5+ days prior to consult and 5+ days following consult, compute average direct cost per day difference, multiply by # of cases. 2) Take all adult non-trauma deaths in your hospital, limit to those with 5+ or 10+ days in hospital, segregate into those with PC consults some days prior to death and those without PC, compare direct costs of those last 5-10 days. Third, refer to the recent Morrison et al. study published in Archives of Internal Medicine. While you probably don't want to replicate something as complicated as propensity score matching, you can at least refer to the results of that study to buttress your own findings. I can also send you the slides and handouts that Kathleen Kerr and I used at CAPC Level II seminar in Orlando last year, if they're not available on the CAPC website anymore. Let me know if this helps. Brian Cassel, VCU PCLC, jbcassel@vcu.edu, 804-628-1926.