Impact of Inpatient Palliative Care Consultation on 30-day Hospital Readmissions and Near Misses Open Access

Binney, Zachary Orion (2013)

Permanent URL:


Introduction: 30-day readmissions are a major financial and quality concern for hospitals. There is limited literature on the role palliative care teams play in reducing readmissions.

Methods: We conducted two analyses of the association between receiving a palliative care consult and risk of all-cause and related 30-day readmissions and near-misses (emergency department visits and observation stays) in a cohort of 34,451 admissions from July 2011-June 2012 at two southern urban academic medical centers. We used propensity scores to match patients with and without a palliative care consult within a pool of 24,809 patients' first admissions during the study period. We used one-to-one nearest-neighbor matching with a caliper. We then adjusted for residual confounding using multivariate conditional logistic regression. We also analyzed 5,649 patients with multiple admissions during the study period as a crossover trial using multivariate conditional logistic regression.

Results: The propensity score-matched cohorts exhibited satisfactory covariate balance. In the matched first admissions there was a trend toward fewer all-cause readmissions and near-misses (adjusted OR (aOR) 0.78, 95% CI 0.59-1.03), but it was not statistically significant. In the crossover analysis there were significant reductions in all-cause readmissions and near misses (aOR 0.76, 95% CI 0.61-0.94), all-cause readmissions only (aOR 0.77, 95% CI 0.62-0.97), and related readmissions only (aOR 0.68, 95% CI 0.49-0.94). There was a trend toward reduced related readmissions and near-misses (aOR 0.76, 95% CI 0.57-1.02).

Discussion: Receiving a palliative care consult was associated with a meaningful reduction in the risk of all-cause and related 30-day readmissions in a cohort of seriously ill patients. The effects may be stronger for patients at higher risk from multiple previous admissions, but the non-significant results in the matched analysis are likely due to a smaller number of observed events. We recommend the use of palliative care consults for patients with serious illness at high risk for readmission.

Table of Contents

Table of Contents

Literature Review 1


Introduction 7

Methods 12

Results 19

Discussion 22

Tables (1-4) and Figures (1-2) 27

Public Health Impact 36

Appendix 38

Works Cited 65

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Partnering Agencies
Last modified

Primary PDF

Supplemental Files