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

Abstract

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

Manuscript

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

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	health services research palliative readmissions
Committee Chair / Thesis Advisor	McClellan, William, Emory University
Committee Members	Quest, Tammie, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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