Document Detail


The role and timing of palliative medicine consultation for women with gynecologic malignancies: Association with end of life interventions and direct hospital costs.
MedLine Citation:
PMID:  24183728     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies.
METHODS: A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥30days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission <3days. Inpatient direct hospital costs were calculated for the last 30days of life from accounting records. Data were analyzed using Fisher's Exact, Mann-Whitney U, Kaplan-Meier, and Student's T testing.
RESULTS: 49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0-3) versus 2 (range 0-6) p=0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30days of life were lower for patients with timely consultation, $0 (range 0-28,019) versus untimely, $7729 (0-52,720), p=0.01.
CONCLUSIONS: Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.
Authors:
Nicole S Nevadunsky; Sharon Gordon; Lori Spoozak; Anne Van Arsdale; Yijuan Hou; Merieme Klobocista; Serife Eti; Bruce Rapkin; Gary L Goldberg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-29
Journal Detail:
Title:  Gynecologic oncology     Volume:  -     ISSN:  1095-6859     ISO Abbreviation:  Gynecol. Oncol.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-11-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0365304     Medline TA:  Gynecol Oncol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013. Published by Elsevier Inc. All rights reserved.
Affiliation:
Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: nevadunskynicole@yahoo.com.
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