Rural Readmissions in the Palliative Care Vacuum

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Palliative care consultation is associated with reduced health care costs and improved quality of life while reducing length of stay. Small rural hospitals lack the depth of multidisciplinary resources to provide inpatient palliative care consult services. The purpose of this research was to assess the need for palliative care service in rural hospitals, while examining for a difference in hospital readmission rates in hospitals lacking palliative consult services. Data were obtained from the Pennsylvania Health Cost Containment Counsel including 3 hospitals with palliative programs and 3 without. Inclusion criteria were admissions for a patient carrying a diagnosis appropriate for palliative consultation between the last quarter of 2014 and 2015. There were 1394 index patients admitted to 3 rural hospitals lacking a palliative consult program. There was a higher rate of readmissions at the nonpalliative hospitals, 71.6% versus 55.1% (P < .001). Data suggest there is a need for palliative telemedicine services to meet needs in rural hospitals.

Palliative care consultation is associated with a more positive patient and family assessment of quality of life in the setting of complex life-limiting illness, while also improving the informed selection of health care choices that reduce the cost of care being provided.1-3 The Center for Advancing Palliative Care identifies palliative care as a multidisciplinary team including nursing, which is beneficial to patients and families facing serious illness.4 This includes, but is not limited to, illnesses such as cancer, cardiac disease, chronic obstructive pulmonary disease, and Alzheimer disease. Palliative consultation is associated with shorter intensive care unit (ICU) length of stay without altering mortality rates or disposition from the ICU.3 Palliative care services are becoming increasingly available in hospitals in urban centers or facilities with a bed capacity of greater than 200. Smaller, more rural hospitals, however, often lack the depth of multidisciplinary resources to provide an inpatient palliative care service.4 There is potential for palliative telemedicine services to reduce the burden to patient and families, as well as cost to the health care system.

The extent of the rural disparity has not been fully explored and represents a significant gap in our knowledge. This research is designed to assess the need for palliative care consultation across a group of 6 hospitals utilizing readmission data in the population appropriate for palliative consultation. Population data were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes for all adult patients with diagnoses appropriate for palliative involvement. Data were obtained from Pennsylvania Health Cost Containment Counsel (PHC4). Three of the selected hospitals have an established palliative care program, and 3 hospitals do not. A correlational analysis of readmission rates was performed between these groups of hospitals in this patient population.





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Patient Care Services / Nursing, Patient Care Services / Nursing Faculty

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