Nevena Skoro

Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs.

To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries.

Body Mass Index (BMI) and Serum Albumin Changes Prior to DeathinChronic Life-Limiting Illness (S714)

Conclusions. PC consults are requested in a minority of patients, and often several days after the RRT encounter. More frequent, earlier involvement of PCmay facilitate goals of care discussions. Implications for research, policy, or practice. Data gathered from this study could inform hospitalsabout resource allocation and the implementation of strategies to decrease hospital mortality, readmissions, and initiate earlier goals of care discussions.

Influence of palliative care consult on radiation therapy utilization for metastatic cancer patients within the last six months.

149 Background: Palliative care encounters (PCE) have been demonstrated to reduce resource utilization and costs within an inpatient setting. Little is known about influence PCE on delivery of radiation therapy (RT). We hypothesize that terminally ill cancer patients completing PCE would have increased utilization of palliative RT (PRT) with decreased fractions and overall costs. METHODS Retrospective review of 3,128 cancer patients that had at least one hospital contact within 6 months prior to death. Data from single academic institution decedent database, hospital billing claims, and radiation oncology electronic medical record (RO EMR) was combined into one database that could be queried. RESULTS From January 2009 to June 2011, 417 patients with soft tissue/bone/not other specified (NOS) excluding brain metastatic disease and at least one palliative contact within 6 months prior to death were identified. Palliative contact: PRT or palliative care consult or admission (PCE). 232 patients completed 321 RT courses (87% palliative, 8% curative, and 5% unknown). 18% of PRT was delivered in 1 fraction, 30% in 2-5, 4% in 6-9, 36% in 10, and 12% > 10 fractions. PRT and PCE were both completed in 48% (33% before, 13% during and 54% after delivery of RT). PCE prior to PRT vs. PCE none/during/after PRT were more likely to result in 5 or fewer PRT treatments (62% vs. 40%, p=0.0309) and there was a trend for increased delivery of single fraction PRT (18 vs. 15%). Based on timing of PCE, no increase in PRT courses per patient and no overall cost reduction was observed beyond direct cost reduction by reducing PRT fractions. Other non-significant factors included sex, race, and payer type. Majority of PCE were within 30 days prior to death 52% vs. only 44% of PRT. CONCLUSIONS Relationship between PCE and PRT is complex and are likely compounded by factors not accounted for in this study. Despite these limitations, PCE prior to delivery of PRT correlates to reduced treatment numbers. This report highlights that overall referrals for palliative services could be integrated into comprehensive cancer much earlier and in a more multi-disciplinary way.

Retrospective assessment of quality of cancer care in last 6 months of life.

234 Background: National organizations such as the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum (NQF) have developed metrics that assess the quality of cancer care. These metrics include consensus standards by the NQF for management of symptoms and end-of-life-care. Cancer centers need feasible methods for self-evaluating their performance on such metrics. METHODS Claims for our cancer patients were matched to Social Security Death Index data to determine date of death.3,128 adult cancer patients died between January 2009 and July 2011 and had at least 1 contact with our center in their last six month of life. All inpatient and outpatient claims data generated in the last six months of life at our hospital were analyzed. RESULTS 32% of patients had an admission in their last 30 days of life, with 15% dying in the hospital. 19% had at least one 30-day readmission in their last six months of life. 6.7% had chemotherapy in the 2 weeks prior to death, and 11.4% in the last month. 27.5% had some contact with the specialist palliative care (SPC) team. Solid tumor patients with SPC earlier than 1 month until death had fewer in-hospital deaths (15.6%) versus those with later or no SPC (19.5%), p=.041. There was no SPC difference for 30-day mortality, or 14- or 30-day chemotherapy metrics. CONCLUSIONS Hospitals can self-evaluate their own performance on NQF endorsed measures, and CMS outcome measures. These data provide additional impetus for earlier integration of specialist palliative care teams. SPC in the last 1-3 weeks of life did not improve most utilization metrics.[Table: see text].