CAPC Palliative Care Discussion Forum
Data Collection and Measurement
Hi Mary --
Unfortunately not.
While a number of prospective quasi-experimental studies and also some retrospective studies have demonstrated an impact on ICU days, there is no pattern of compelling data demonstrating a reduction in total LOS. In terms of ethics you would want to hypothesize a reduced LOS only for survivors (for decedents, no impact, as PC is not intended to either hasten or prolong death). To be useful to this question, any research on this would have to analyze survivors separately from decedents. Only two published studies have included survivors and analyzed them separately from decedents. The recently published 8-hospital study with more than 25,000 cases analyzed (Morrison et al., 2008), found no difference (p=.12) in LOS for live discharges, comparing the PC (13.1 days) and usual care (12.4 days) cohorts. Schneiderman & Gilmer’s (2003) study of ethics consultations showed no impact on live discharges’ LOS (means and p value not reported). Even the Gade Venohr & Conner (JPM 2008) randomized clinical trial of PC consults in Kaiser Permanente hospitals did not demonstrate any impact on LOS in the index hospitalization (though they did not separate survivors and decedents, they had relatively small % of decedents and the LOS was identical in the two arms).
My recommendations are to
1) Based on the published literature you should not raise any expectations in your hospital that your program will be able to demonstrate and quantify a reduced LOS.
2) Thus you should use only the Advanced Version of the CAPC Impact Calculator, rather than the basic version, and you should zero-out the anticipated impact on LOS. See http://www.capc.org/impact_calculator_detailed/
3) However, when you evaluate your program as you implement it, you should keep your eyes open for specific cases of survivors where a PC consult clearly resolved symptoms or family issues or clarified goals of care and this paved the way for discharge to a safe setting. There's nothing to keep you from highlighting such individual cases when you report your results internally.
Please let me know what you think. Thanks,
Brian Cassel, VCU PCLC
jbcassel@vcu.edu
804-628-1926
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Re:Outcomes Data: Affecting Early Discharge
I appreciate your suggestions and do plan to keep track of any impact that we make for the patients that we consult on... including specific cases and patient stories of success. There is such a desire to 'prove our worth/work' to the financial administrators. Thus far, we are pointing towards the positive impact in quality of life as well as potential cost savings by reducing inappropriate care interventions and improved communication/ symptom control. We'll see where it takes us.
Mary