Standardized Criteria for Integrated Palliative Care Consultation on the Solid Tumor Oncology Service (S752)

Abstract

Objectives 1. Discuss the role of standardized criteria for palliative care consultation among patients with advanced solid malignancies. 2. Discuss the outcomes of standardized PC consult on quality metrics: 30-day readmission, inpatient mortality, and length of stay. Background. A recent study demonstrated that routine integration of Palliative Care for patients with advanced lung cancer is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. We hypothesized that implementing routine palliative care consultation for solid tumor oncology patients using standardized referral criteria within a real world clinical setting would be associated with improved quality of care. Research Objectives. To evaluate the effectiveness of standardized criteria for PC consults in improving quality metrics on an oncology solid tumor service. Methods. We implemented a 3-month quality intervention (n=65) on the solid tumor oncology service that mandated a palliative care consultation for patients with one or more of the following criteria: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within prior 30 days, >7 day hospitalization, or uncontrolled symptoms. Two baseline groups were used for comparison: 1) Patients who met eligibility in a six week period prior to the intervention (n=48) (group 1); 2) Hospital Dashboard (University HealthSystem Consortium) quality metric averages over a 1-year period prior to the intervention which included all solid tumor patients (n=571) (group 2). Primary outcomes were: hospice utilization, solid tumor mortality index, 30-day readmission rate and length of stay. Results. Comparing Group 1 to the Intervention group, palliative care consultation doubled from 41% to 80%; 30-day readmission decreased from 36% to 17% (p=.022); and hospice utilization increased from 14% to 25% (p=0.146). Dashboard data (Group 2 vs. Intervention) showed: mortality index improved (1.35 to 0.59) and 30-day readmission rates decreased from 21.7% to 13.5% (p=0.026). No differences were observed in length of stay comparing either group 1 or 2 to the intervention. Conclusions. Integrating standardized palliative care consults for patients with solid malignancies, who are at the highest risk for in-hospital death and readmission, improved 30-day readmission, oncology service mortality, and hospice utilization. Implications for research, policy, or practice. The results of this quality improvement project demonstrate that among patients with advanced solid malignancies, PCconsultation using standardized criteria decreased readmission rates and inpatient mortality. Rates of readmission and inpatient mortality are commonly being used as markers for overall hospital quality and are being linked to reimbursement. This project can inform practice and can be replicated at other institutions and with other high-risk serious illnesses to improve quality of care.