Hospital outcomes for a home-based palliative medicine consulting service

J Palliat Med. 2013 Feb;16(2):179-84. doi: 10.1089/jpm.2012.0414. Epub 2013 Jan 11.


Background: There is a growing need for palliative care services located outside of hospitals.

Objective: This study's objective was to evaluate a home-based, nonhospice, palliative medicine (PM) consultation practice within a fee-for-service environment.

Method: Hospital and emergency department (ED) utilization and cost data obtained from administrative records were analyzed with longitudinal analyses to compare use 18 months before and after service enrollment in a single patient group.

Participants: Patients (N=369) with advanced complex illness (ACI) referred for home-based palliative consultation participated in the study.

Intervention: Consultation conducted by nurse practitioners included a multidimensional assessment with recommendations to outpatient physicians for symptom management and guidance to patient and family for goals of treatment and advanced care planning (ACP). Nurse practitioners were supported by a collaborating PM physician. Follow-up visits varied by need for symptom management and ACP.

Results: Total hospitalizations, total hospital days, total and variable costs, and probability of a 30-day readmission were significantly reduced in the 18-month period following program enrollment. However, probability of an ED visit was not reduced.

Conclusions: While requiring replication with rigorous methods, preliminary results suggest a home-based PM practice may reduce hospital utilization for ACI patients.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Chi-Square Distribution
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Home Care Services / organization & administration*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Nurse Practitioners
  • Palliative Care / organization & administration*
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies