Palliative Care Consultation for Goals of Care and Future Acute Care Costs: A Propensity-Matched Study

Am J Hosp Palliat Care. 2018 Jul;35(7):966-971. doi: 10.1177/1049909117743475. Epub 2017 Nov 23.


Background: Hospitals are under increasing pressure to manage costs across multiple episodes of care. Most studies of the financial impact of palliative care have focused on costs during a single hospitalization.

Objective: To compare future acute health-care costs and utilization between patients who received inpatient palliative care consultation for goals of care (Palliative Care Service [PCS]) and a propensity-matched cohort of patients who did not receive palliative care consultation (non-PCS) in a single academic medical center.

Methods: Data were extracted from the hospital's electronic records for admissions and discharges between July 2014 and October 2016. A stratified propensity score matching was used to account for nonrandom assignment and potential inherent differences between PCS and non-PCS groups using variables of theoretical interest: age, gender, race, diagnosis, risk of mortality, and prior acute care costs.

Results: The analytical sample for this study included 41 363 patients (PCS = 1853; non-PCS = 39 510). Future acute care costs were significantly higher in the non-PCS group after propensity score matching (highest tier = US$15 654 vs US$8831; second highest tier = US$12 200 vs US$5496; P = .0001). The non-PCS group also had significantly higher future acute care utilization across all propensity tiers and outcomes including 30-day readmission ( P = .0001), number of future hospital days ( P = .0001), and number of future intensive care unit days ( P = .0001).

Conclusion: Palliative care consultations for goals of care may decrease future health-care utilization with cost savings that persist into future hospitalizations.

Keywords: health services research; health-care costs; palliative care; readmissions.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Cost Savings / methods*
  • Female
  • Health Care Costs
  • Humans
  • Length of Stay / economics*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Palliative Care / economics*
  • Palliative Care / organization & administration
  • Patient Care Planning / economics*
  • Patient Care Planning / organization & administration
  • Patient Readmission / economics
  • Propensity Score
  • Referral and Consultation / economics