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Member Research & Reports

Member Research & Reports

Brown: Palliative Care Consultations in Nursing Homes and Reductions in Acute Care Use and Potentially Burdensome End-of-Life Transitions

Palliative care optimizes the quality of life of persons with serious illness by anticipating, preventing, and alleviating suffering across the care continuum. To expand access to palliative care expertise in nursing homes beyond that currently available through Medicare hospice, some nursing homes now offer palliative care consultations by external providers, primarily nurse practitioners, with palliative care expertise. However, there is a lack of empirical evidence of the value of this new approach.

Miller, Susan
[Photo: Dr. Susan Miller]

The purpose of this study, led by Dr. Susan Miller, professor of health services, policy and practice, was to evaluate how receipt and timing of nursing home palliative care consultations are associated with end-of-life care transitions and acute care use.

The researchers used a retrospective cohort study design to identify residents of 46 nursing homes in Rhode Island and North Carolina who had died between 2006 and 2010, with an initial palliative care consultation within 180 days of death. Treatment groups were created using days between the initial consultation and death (<7, 8-30, 31-60, and 61-180). Outcomes of interest included hospitalizations and Emergency Department visits in the last days of life. The occurrence of any potentially burdensome end-of-life care transition was also examined, which was defined as hospitalization or hospice admission within three days of death or two or more hospitalizations or ED visits in the last 30 days of life. Matched patients who did not receive consultations were used as case controls.

In the 46 study nursing homes, 10 percent of the 6,458 residents who died between 2006 and 2010 had initial palliative care consultations in the last 180 days of life. Dr. Miller and her colleagues found that residents with consultations had lower rates of hospitalization than controls, with rates lowest when initial consultations were furthest from death. For instance, in residents with initial consultations 61 to 180 days before death, the adjusted hospitalization rate in the last seven days of life was 7 percent, versus 23 percent in controls. Also, potentially burdensome transition rates were lower when consultations were 61 to 180 days before death.

This study provides the first empirical evidence of the value of palliative care consultations provided in nursing homes. Findings suggest that Medicare and provider policy supporting concurrent specialty care consultations in nursing homes may lead to reductions in costly and often unsettling and discretionary hospital use – use that is likely to undermine residents’ quality of life.

This study was published in Journal of the American Geriatrics Society.

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